Details

Autor(en) / Beteiligte

• Xu, Jane
• Adams, Susan
• Liu, Yingrui Cyril
• Karpelowsky, Jonathan

Titel

Nonoperative management in children with early acute appendicitis: A systematic review

Ist Teil von

• Journal of pediatric surgery, 2017-09, Vol.52 (9), p.1409-1415

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2017

Quelle

ScienceDirect Pay Per View(PPV) Titles

Beschreibungen/Notizen

• Abstract Purpose Appendectomy has remained the gold standard treatment of acute appendicitis for more than 100 years. Nonoperative management (NOM) has been shown to be a valid treatment alternative for acute uncomplicated appendicitis in adults. A systematic review of available evidence comparing operative management (OM) and NOM in children with acute uncomplicated appendicitis was performed. Methods Systematic searches of MedLine, Embase, and a clinical trial register ( https://clinicaltrials.gov/) were performed in March 2016. Only articles that studied NOM for uncomplicated appendicitis in children were included. Data generation was performed independently by two authors, and quality was assessed using the rating schema by the Oxford Centre for Evidence-Based Medicine. Results 15 articles were selected: four retrospective analyses, four prospective cohort studies, four prospective nonrandomized comparative trials and one randomized controlled trial (RCT). Initial success of the NOM groups (a cure within two weeks of intervention) ranged from 58 to 100%, with 0.1–31.8% recurrence at one year. Conclusion Although present literature is scarce, publications support the feasibility of further studies investigating NOM of acute uncomplicated appendicitis in children. Higher quality prospective RCTs with larger sample sizes and robust randomization methods, studying the noninferiority of NOM with antibiotics compared with OM are required to establish its utility. Level of evidence This manuscript is a systematic review and thus assigned the lowest evidence used from the manuscripts analyzed which is a Level IV.