Comparison of the Efficacy and Safety of Antibiotic Treatment and Appendectomy for Acute Uncomplicated Appendicitis: A Systematic Review and Meta-analysis

Abstract

Abstract Objective This meta-analysis compared antibiotic treatment with appendectomy for uncomplicated appendicitis. Methods We searched Pubmed, EMBASE, Cochrane, Web of science, CNKI, VIP, and Wanfang for randomized controlled studies comparing appendectomy with antibiotic treatment for uncomplicated acute appendicitis. The primary outcome included complication-free treatment success at 1 year, complications, surgical complications, and the complicated appendicitis rates. Secondary outcomes included negative appendicitis, length of hospital stay, the quality of life at 1 month, and the impact of an appendicolith on antibiotic therapy. Results 12 randomized controlled studies were included. Compared with surgery group, the antibiotic group decrease the complication-free treatment success at 1 year (RR 0.81; 95% CI 0.73–0.91; z = 3.65;p = 0.000). Statistically significance of the complications between antibiotic group and surgical group with both surgical types(open and laparoscopic) (RR 0.43; 95% CI 0.31–0.58; P = 0.000;z = 5.36), but no between the antibiotic treatment and laparoscopic surgery (RR 0.72; 95% CI 0.41–1.24; z = 1.19;P = 0.236).There was no statistically significant differences between two groups of surgical complications(RR 1.38; 95% CI 0.70–2.73; z = 0.93;p = 0.353), the complicated appendicitis rate(RR 0.71; 95% CI 0.36–1.42; z = 0.96;p = 0.338), negative appendicectomy rate(RR 1.11; 95% CI 0.69–1.79; z = 0.43; p = 0.670), duration of hospital stay(SMD 0.08;95%CI -0.11-0.27; z = 0.80; p = 0.422), and quality of life at 1 month (SMD 0.09; 95%CI -0.03-0.20; z = 1.53; p = 0.127). However, in the antibiotic treatment group, appendicolith rates were statistically higher in those whose symptoms did not improve (RR 2.94; 95% CI 1.28–6.74; z = 2.55;p = 0.011). Conclusions Although the cure rate of antibiotics is lower than surgery, antibiotic treatment is still a reasonable option for patients with uncomplicated acute appendicitis who do not want surgery without having to worry about complications or complicating the original illness.