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<p>The management of acute appendicitis has undergone a&#xa0;substantial transformation in recent years, transitioning from mandatory surgical intervention to more individualized treatment strategies. This systematic review and meta-analysis aim to evaluate current evidence comparing laparoscopic and open appendectomy with non-operative management using antibiotics, highlighting clinical outcomes, recurrence risk, and complication profiles. We conducted a&#xa0;comprehensive search of PubMed, Embase, and the Cochrane Library databases for studies published from January 1995 to February 2025. Eligible studies compared surgical and conservative treatments in adult or pediatric patients with acute appendicitis. Thirty-four studies involving 374,201 patients met the inclusion criteria. Laparoscopic appendectomy demonstrated superior outcomes over open surgery in terms of recovery time, wound infection rates, and hospital stay. Primary estimates for non-operative management were restricted to imaging-confirmed uncomplicated appendicitis with CT-only sensitivity analyses; meta-regression examined imaging modality, calendar time, and the COVID-19 period. Non-operative management with antibiotics achieved a&#xa0;short-term success rate of 73.2% but was associated with a&#xa0;recurrence rate approaching 24% within 1&#xa0;year. Imaging accuracy, particularly via CT, played a&#xa0;critical role in identifying suitable candidates for conservative treatment. Findings were consistent across prespecified subgroups (sex, body mass index, comorbidity) and robust in CT-only sensitivity and meta-regression analyses.</p><p>While laparoscopic appendectomy remains the most definitive and effective treatment for acute appendicitis, non-operative management may be appropriate for carefully selected patients with uncomplicated disease. Treatment decisions should be guided by diagnostic precision, patient-specific risk profiles, and long-term safety considerations.</p>

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Reappraising appendicitis: a systematic review and meta-analysis of evolving treatment paradigms

  • 期刊论文

  • 发表日期：

    2025年11月7日

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  • Baris Zulfikaroglu

摘要

The management of acute appendicitis has undergone a substantial transformation in recent years, transitioning from mandatory surgical intervention to more individualized treatment strategies. This systematic review and meta-analysis aim to evaluate current evidence comparing laparoscopic and open appendectomy with non-operative management using antibiotics, highlighting clinical outcomes, recurrence risk, and complication profiles. We conducted a comprehensive search of PubMed, Embase, and the Cochrane Library databases for studies published from January 1995 to February 2025. Eligible studies compared surgical and conservative treatments in adult or pediatric patients with acute appendicitis. Thirty-four studies involving 374,201 patients met the inclusion criteria. Laparoscopic appendectomy demonstrated superior outcomes over open surgery in terms of recovery time, wound infection rates, and hospital stay. Primary estimates for non-operative management were restricted to imaging-confirmed uncomplicated appendicitis with CT-only sensitivity analyses; meta-regression examined imaging modality, calendar time, and the COVID-19 period. Non-operative management with antibiotics achieved a short-term success rate of 73.2% but was associated with a recurrence rate approaching 24% within 1 year. Imaging accuracy, particularly via CT, played a critical role in identifying suitable candidates for conservative treatment. Findings were consistent across prespecified subgroups (sex, body mass index, comorbidity) and robust in CT-only sensitivity and meta-regression analyses.

While laparoscopic appendectomy remains the most definitive and effective treatment for acute appendicitis, non-operative management may be appropriate for carefully selected patients with uncomplicated disease. Treatment decisions should be guided by diagnostic precision, patient-specific risk profiles, and long-term safety considerations.