Should non-operative management be considered in uncomplicated acute appendicitis? Study sheds light

Boston: Nonoperative management with antibiotics may be an alternative option to appendectomy in adult patients presenting with uncomplicated acute appendicitis, but there may be the possibility of longer hospital stays and potentially higher rates of recurrent appendicitis, informs an article published in the JAMA Surgery.

Appendicitis, an inflammation of the appendix, is a very common disease with a lifetime risk of approximately 7-8% worldwide. Acute appendicitis (AA) is the most common abdominal and surgical emergency. Appendectomy remains the standard care for uncomplicated AA as it is generally well tolerated. However, it is associated with substantial intraoperative and postoperative risks, such as infection, scars, and delayed recovery. Non-operative management (NOM) of AA with antibiotics has been devised as a viable alternative to surgery, as it may be associated with avoidance of surgical scars, reduction of postoperative pain, and faster recovery. Several randomized clinical trials point to the safety and efficacy of nonoperative management of uncomplicated AA. Thus, a meta-analysis of randomized clinical trials may contribute to the body of evidence and help surgeons select which patients may benefit from surgical and nonsurgical treatment.

de Almeida Leite RM, Massachusetts General Hospital, Boston and colleagues conducted a systematic review and meta-analysis study to assess the efficacy and safety of nonoperative management vs appendectomy for acute uncomplicated appendicitis.

Researchers searched Embase and PubMed databases for published randomized clinical trials comparing nonoperative management with appendectomy in adult patients presenting with uncomplicated acute appendicitis. 8 studies met the inclusion criteria and were selected for the study. The main outcome was treatment success and major adverse effects at 30 days' follow-up.

Key findings of the analysis,

• The main outcome was not significantly different in the operative and nonoperative management cohorts (RR- 0.85).

• The percentage of major adverse effects was similar in both cohorts (RR-0.72).

• In the nonoperative management group, the length of stay was significantly longer (RR-1.48) and a median cumulative incidence of 18% of recurrent appendicitis was observed.

Researchers conclude that nonoperative management is a generally safe and efficient treatment option for uncomplicated acute appendicitis. However, this strategy may be associated with an increase in the duration of hospital stay and a higher rate of recurrent appendicitis.

The present meta-analysis may help practicing surgeons in the decision-making of nonoperative management for uncomplicated acute appendicitis.

Reference:

de Almeida Leite RM, Seo DJ, Gomez-Eslava B, et al. Nonoperative vs Operative Management of Uncomplicated Acute Appendicitis: A Systematic Review and Meta-Analysis. JAMA Surg. Published online July 27, 2022. doi:10.1001/jamasurg.2022.2937