SURGICAL VS NON-SURGICAL MANAGEMENT OF UNCOMPLICATED PEDIATRIC APPENDICITIS: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS melissa_ochoa_cortez@hotmail.com

 

SURGICAL VS NON-SURGICAL MANAGEMENT OF UNCOMPLICATED PEDIATRIC APPENDICITIS: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

8

Mexico

Oral or Poster

Acute appendicitis remains one of the most frequent indications for pediatric abdominal surgery. While appendectomy has traditionally been the standard of care, antibiotic-based non-surgical management has gained attention for uncomplicated cases. However, its safety and efficacy compared to surgery remain uncertain.

A systematic review and meta-analysis were performed using PubMed, Scopus, and Web of Science through June 12, 2025. Randomized controlled trials comparing antibiotic therapy with appendectomy in children were included. A random-effects model (RStudio version 4.5.0) was applied. Mean differences were calculated for continuous variables and relative risks for dichotomous variables, both with 95% confidence intervals. Heterogeneity was assessed with the I² statistic.

Seven trials comprising 1,386 patients were analyzed. Surgical management significantly reduced the risk of perforated appendicitis (RR: 3.76; 95%: 1.52; 9.28) and treatment failure (RR: 5.20; 95%: 3.76; 7.18). Reoperation rates within one year were also lower in the surgical group (RR: 14.55; 95%: 5.00; 42.38), and hospital stay was slightly shorter (MD: 0.44 days; 95%: 0.05; 0.84). Conversely, non-surgical therapy allowed earlier return to normal activities (MD: –5.90 days; 95%: –9.83; –1.96).

Surgery offers superior outcomes in terms of complications, recurrence, and reoperations, reinforcing its role as the preferred strategy for pediatric uncomplicated appendicitis. Although non-surgical management facilitates faster functional recovery, its higher failure and complication rates limit routine adoption.