Early versus delayed (interval) appendicectomy for the management of appendicular abscess and phlegmon: a systematic review and meta-analysis
- 31 July 2021
- journal article
- review article
- Published by Springer Science and Business Media LLC in Langenbecks Archiv für Chirurgie
- Vol. 406 (5), 1341-1351
- https://doi.org/10.1007/s00423-020-02042-3
Abstract
Objective The safety and role of emergency (EA) versus interval appendicectomy (IA) for appendicular abscess and phlegmon remains debatable with no optimal strategy identified. The aim of this systematic review and meta-analysis is to evaluate outcomes of managing appendicular abscesses and phlegmon with emergency or interval appendicectomy. Methods We conducted a systematic search of electronic databases using key terms including 'appendicular abscess', 'appendicular phlegmon' and 'interval appendicectomy'. Randomised controlled trials and observational studies comparing the two management approaches were included. Operative time, post-operation complication, unplanned bowel resection, rate of surgical site infection, post-operative length of stay and overall mortality rate were evaluated. Results We identified six studies (2 RCTs and 4 observational studies) with a total of 9264 patients of whom (n = 1352) underwent IA, and (n 7912) underwent EA. The EA group was associated with statistically significant unplanned bowel resection (OR 0.55, 95% CI [0.33-0.90], P = 0.02) and longer total operating time (MD - 14.11, 95% CI [- 18.26-- 9.96] P = 0.00001). However, the following parameters were compared for both EA and IA groups; there were no significant statistical differences: surgical site infection (OR 0.49, 95% CI [0.17-1.38], P = 0.18), post-operative intra-abdominal collection (RD - 0.01, 95% CI [- 0.04-0.01], P = 0.29), total length of hospital stay (MD 1.83, 95% CI [- 0.19-3.85], P = 0.08), post-operative length of hospital stay (MD - 0.27, 95% CI [- 3.66-3.13], P = 0.88) and mortality rate (MD - 0.27, 95% CI [- 3.66-3.13], P = 0.66). Conclusion Emergency operation for appendicular abscess and phlegmon may lead to a higher rate of reported morbidity when compared with interval appendicectomy. Although emergency appendicectomy performed for appendicular abscess and phlegmon is a feasible and safe operative approach, it is associated with significantly increased operative time and unplanned bowel resection (ileocolic and right hemicolectomies) compared to interval appendicectomy.This publication has 27 references indexed in Scilit:
- Management of Appendiceal Mass and Abscess. An 11-Year ExperienceInternational Surgery, 2015
- Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitisEmergencias, 2015
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trialsBMJ, 2011
- A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon)Surgery, 2010
- Laparoscopic Versus Open Appendectomy in Adults with Complicated Appendicitis: Systematic Review and Meta‐analysisWorld Journal of Surgery, 2010
- Initial laparoscopic appendectomy versus initial nonoperative management and interval appendectomy for perforated appendicitis with abscess: a prospective, randomized trialJournal of Pediatric Surgery, 2010
- Management of Appendicitis Presenting with Abscess or MassJournal of the Korean Society of Coloproctology, 2010
- Nonsurgical Treatment of Appendiceal Abscess or PhlegmonAnnals of Surgery, 2007
- Routine interval appendectomy is unnecessary after conservative treatment of appendiceal massColorectal Disease, 2007
- Appendix mass: do we know how to treat it?The Annals of The Royal College of Surgeons of England, 2005