Appendicitis is an acute inflammation of the appendix that can lead to an abscess, ileus, peritonitis, or death. Appendicitis is the most common abdominal surgical emergency, with a lifetime risk of approximately 7% to 9% in the USA. Mortality from acute appendicitis is less than 0.3%, but rises to 1.7% after perforation.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute appendicitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 16 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, laparoscopic surgery, ligation, open surgery, stump inversion, and surgery.
The incidence of acute appendicitis is falling, although the reasons are unclear.
Appendicitis is the most common abdominal surgical emergency, with a lifetime risk of approximately 7% to 9% in the USA.Potential causes of appendicitis include faecoliths, lymphoid hyperplasia, fibrous bands, foreign bodies, and caecal carcinoma, all of which can lead to obstruction of the appendix lumen.Mortality from acute appendicitis is <0.3%, but rises to 1.7% after perforation.
Spontaneous resolution of acute appendicitis has been reported in at least 10% of episodes.
Very limited evidence suggests that conservative treatment of acute appendicitis with antibiotics may reduce pain and morphine consumption, but that one third of people are likely to be readmitted with acute appendicitis requiring surgery within 1 year.
Standard treatment for acute appendicitis is appendicectomy.
Clinical trials to compare surgery with no treatment would be considered unethical, and have not been done.There is good evidence that laparoscopic surgery in adults reduces wound infections, postoperative pain, duration of hospital stay, and time off work compared with open surgery, but increases the risk of intra-abdominal abscesses.Limited evidence suggests that laparoscopic surgery in children may reduce wound infections and duration of hospital stay compared with open surgery, but it has not been shown to reduce other complications.There is some evidence to suggest that stapling reduces operative time compared with endoloops, but no reliable evidence to suggest that it reduces other complications.We don't know how natural orifice surgery compares with laparoscopic surgery, as we found no RCTs.There is limited evidence to suggest that stump inversion has an increased rate of wound infection compared with simple ligation, and no difference in rate of intra-abdominal abscess formation.
The most common complication of appendicectomy is wound infection, with intra-abdominal abscess formation less common.
Treatment with surgery plus antibiotics reduces wound infections and intra-abdominal abscesses compared with surgery alone in adults with simple or complicated appendicitis.However, in children, the benefit of antibiotics may be limited to those with complicated appendicitis.