Meta‐analysis of antibiotics versus appendicectomy for non‐perforated acute appendicitis. BJS 2016; 103: 656-667.
Published: 17th March 2016
Authors: V. Sallinen, E. A. Akl, J. J. You, A. Agarwal, S. Shoucair, P. O. Vandvik et al.
For more than a century, appendicectomy has been the treatment of choice for appendicitis. Recent trials have challenged this view. This study assessed the benefits and harms of antibiotic therapy compared with appendicectomy in patients with non‐perforated appendicitis.
A comprehensive search was conducted for randomized trials comparing antibiotic therapy with appendicectomy in patients with non‐perforated appendicitis. Key outcomes were analysed using random‐effects meta‐analysis, and the quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (
Five studies including 1116 patients reported major complications in 25 (4·9 per cent) of 510 patients in the antibiotic and 41 (8·4 per cent) of 489 in the appendicectomy group: risk difference −2·6 (95 per cent c.i. –6·3 to 1·1) per cent (low‐quality evidence). Minor complications occurred in 11 (2·2 per cent) of 510 and 61 (12·5 per cent) of 489 patients respectively: risk difference −7·2 (−18·1 to 3·8) per cent (very low‐quality evidence). Of 550 patients in the antibiotic group, 47 underwent appendicectomy within 1 month: pooled estimate 8·2 (95 per cent c.i. 5·2 to 11·8) per cent (high‐quality evidence). Within 1 year, appendicitis recurred in 114 of 510 patients in the antibiotic group: pooled estimate 22·6 (15·6 to 30·4) per cent (high‐quality evidence). For every 100 patients with non‐perforated appendicitis, initial antibiotic therapy compared with prompt appendicectomy may result in 92 fewer patients receiving surgery within the first month, and 23 more experiencing recurrent appendicitis within the first year.
The choice of medical
You may also be interested in
Early MRI predictors of disease‐free survival in locally advanced rectal cancer from the GRECCAR 4 trial.
Authors: S. Nougaret, F. Castan, H. de Forges, H. A. Vargas, B. Gallix, S. Gourgou et al.
Secondary technical resectability of colorectal cancer liver metastases after chemotherapy with or without selective internal radiotherapy in the randomized SIRFLOX trial.
Authors: B. Garlipp, P. Gibbs, G. A. Van Hazel, R. Jeyarajah, R. C. G. Martin, C. J. Bruns et al.
Population‐based study of the impact of small bowel obstruction due to adhesions on short‐ and medium‐term mortality.
Authors: R. Behman, A. B. Nathens, B. Haas, N. Look Hong, P. Pechlivanoglou, P. Karanicolas et al.
Authors: M. E. Stellingwerf, S. Sahami, D. C. Winter, S. T. Martin, G. R. D'Haens, G. Cullen et al.
Long‐term follow‐up of the AVOD randomized trial of antibiotic avoidance in uncomplicated diverticulitis.
Authors: D. Isacson, K. Smedh, M. Nikberg, A. Chabok
Pushing the boundaries of pelvic exenteration by maintaining survival at the cost of morbidity. BJS 2019; 106: 1393-1403.
Authors: R. L. Venchiarutti, M. J. Solomon, C. E. Koh, J. M. Young, D. Steffens
Meta‐analysis of the role of colonoscopy after an episode of left‐sided acute diverticulitis. BJS 2019; 106: 988-997.
Authors: S. J. Rottier, S. T. Dijk, A. A. W. Geloven, W. H. Schreurs, W. A. Draaisma, W. A. Enst et al.
Randomized clinical trial
Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer.
Authors: S. Pucciarelli, P. Del Bianco, U. Pace, F. Bianco, A. Restivo, I. Maretto et al.
Authors: T. O. Sillo, A. D. Beggs, D. G. Morton, G. Middleton
Meta‐analysis of the effect of extending the interval after long‐course chemoradiotherapy before surgery in locally advanced rectal cancer. BJS 2019; 106: 1298-1310.
Authors: É. J. Ryan, D. P. O'Sullivan, M. E. Kelly, A. Z. Syed, P. C. Neary, P. R. O'Connell et al.
Randomized clinical trial
Randomized clinical trial of accelerated enhanced recovery after minimally invasive colorectal cancer surgery (RecoverMI trial). BJS 2019; 106: 1311-1318.
Authors: B. K. Bednarski, T. P. Nickerson, Y. N. You, C. A. Messick, B. Speer, V. Gottumukkala et al.
Organoids from colorectal peritoneal metastases as a platform for improving hyperthermic intraperitoneal chemotherapy. BJS 2019; 106: 1404-1414.
Authors: I. Ubink, A. C. F. Bolhaqueiro, S. G. Elias, D. A. E. Raats, A. Constantinides, N. A. Peters et al.