The aim of this study is to provide a meta-analysis of randomized controlled trials (RCT) comparing conservative and surgical treatment in a population of adults with uncomplicated acute appendicitis. A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in MEDLINE, Embase, and CENTRAL. We have exclusively incorporated randomized controlled trials (RCTs). Studies involving participants with complicated appendicitis or children were excluded. The variables considered are as follows: treatment complications, complication-free treatment success at index admission and at 1 year follow-up, length of hospital stay (LOS), quality of life (QoL) and costs. Eight RCTs involving 3213 participants (1615 antibiotics/1598 appendectomy) were included. There was no significant difference between the two treatments in terms of complication rates (RR = 0.66; 95% CI 0.61—1.04, P = 0.07, I2 = 69%). Antibiotics had a reduced treatment efficacy compared with appendectomy (RR = 0.80; 95% CI 0.71 to 0.90, p < 0.00001, I2 = 87%) and at 1 year was successful in 540 out of 837 (64.6%, RR = 0.69, 95% confidence interval 0.61 to 0.77, p < 0.00001, I2 = 81%) participants. There was no difference in LOS (mean difference − 0.58 days 95% confidence interval − 1.59 to 0.43, p = 0.26, I2 = 99%). The trial sequential analysis has revealed that, concerning the three primary outcomes, it is improbable that forthcoming RCTs will significantly alter the existing body of evidence. As further large-scale trials have been conducted, antibiotic therapy proved to be safe, less expensive, but also less effective than surgical treatment. In order to ensure well-informed decisions, further research is needed to explore patient preferences and quality of life outcomes.

中文翻译：

---

比较非手术与手术治疗单纯性阑尾炎的荟萃分析和试验序贯分析：重点关注随机对照试验


本研究的目的是对患有无并发症的急性阑尾炎的成人人群中比较保守治疗和手术治疗的随机对照试验 (RCT) 进行荟萃分析。根据系统评价和荟萃分析的首选报告项目 (PRISMA) 指南进行了系统的文献综述。在 MEDLINE、Embase 和 CENTRAL 上进行了全面检索。我们专门纳入了随机对照试验 (RCT)。涉及患有复杂性阑尾炎或儿童的研究被排除在外。考虑的变量如下：治疗并发症、入院时和 1 年随访时的无并发症治疗成功率、住院时间 (LOS)、生活质量 (QoL) 和费用。纳入了 8 项随机对照试验，涉及 3213 名参与者（1615 名抗生素/1598 名阑尾切除术）。两种治疗的并发症发生率无显着差异（RR = 0.66；95% CI 0.61-1.04，P = 0.07，I2 = 69%）。与阑尾切除术相比，抗生素的治疗效果较低（RR = 0.80；95% CI 0.71 至 0.90，p < 0.00001，I2 = 87%），1 年时 837 例患者中有 540 例成功（64.6%，RR = 0.69，95 % 置信区间 0.61 至 0.77，p < 0.00001，I2 = 81%）参与者。 LOS 没有差异（平均差异 - 0.58 天 95% 置信区间 - 1.59 至 0.43，p = 0.26，I2 = 99%）。试验序贯分析显示，关于三个主要结局，即将进行的随机对照试验不太可能显着改变现有证据。随着进一步大规模试验的进行，抗生素治疗被证明是安全的、便宜的，但也不如手术治疗有效。 为了确保做出明智的决策，需要进一步研究来探索患者的偏好和生活质量结果。