SP 10.06 Surgical Versus Conservative Management for The Treatment of Appendicular Masses: A Systematic Review and Meta-Analysis
Fawaaz Ul-Haq, Wajeeh Ullah Mahmood, Shaiat Uddin, Goldie Khera, Krishna K Singh, Muhammad S SajidAbstract
Background
The objective of this article is to evaluate the effectiveness of surgical versus conservative management in patients with appendicular masses.
Methods
Standard medical databases such as MEDLINE, Embase, Pubmed, and Cochrane Library were searched to find randomised, controlled trials (RCTs) comparing surgical versus conservative management in patients with appendicular masses. All data was analysed using Review Manager Software 5.4, and the meta-analysis was performed with the random effect model analysis.
Results
A total of 7 RCTs were included recruiting 365 patients undergoing either surgical or conservative management. In the random effect model analysis, fewer complications were noted with conservative management than surgical management for appendicular masses (Risk ratio [RR]: 2.86; 95% confidence interval [CI] [1.05, 7.79], z = 2.06, P = 0.04), although length of stay was increased with conservative management compared to surgical management (RR: -0.88; 95% CI [-1.69, -0.06], z = 2.11, P = 0.04). Despite this, conservative management was more likely to require additional interventions such as percutaneous drainage compared to surgical management (RR: 0.19; 95% CI [0.09, 0.38], z = 4.60, P <0.00001).
Conclusion
Conservative management with antibiotics is associated with fewer complications, but with higher intervention rates and an increased length of stay compared to surgical management for appendicular masses.