Antibiotic-Based Nonoperative Management Versus Appendectomy for Uncomplicated Acute Appendicitis in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- 1College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
- 2Al Dhaid Hospital, Sharjah P.O. Box 70225, United Arab Emirates
- 3University Hospital of Sharjah, Sharjah P.O. Box 72772, United Arab Emirates
Abstract
Background/Objectives: Acute appendicitis is the leading cause of emergency abdominal surgery in children. Although appendectomy remains the standard treatment, antibiotic-based nonoperative management (NOM) is an alternative for selected patients. We performed an updated systematic review and meta-analysis of randomized controlled trials (RCTs) comparing these strategies in pediatric uncomplicated acute appendicitis. Methods: PubMed, MEDLINE via Ovid, Scopus, and CINAHL were searched through 15 July 2026; CENTRAL and ClinicalTrials.gov were searched on 13 October 2026 (PROSPERO: CRD420261447254). Pediatric RCTs were included. RoB 2 and GRADE were used. Random-effects pooling required compatible outcomes. Results: Eight RCTs involving 1920 children were included. Both one-year comparative trials favored appendectomy, but their different composite endpoints were not pooled. NOM avoided appendectomy at one year in 62.5–70.0% in three trials. Clinical complications were uncertain (RR 1.61, 95% CI 0.63–4.13; I2 = 54.9%). No significant pooled difference was found in hospital stay or return to normal activities. Recurrence and school outcomes were reported separately. Conclusions: Appendectomy provides more reliable definitive treatment. NOM can avoid surgery in selected children but carries a risk of subsequent failure or recurrence. Comparative safety and recovery remain uncertain. Families should be informed of these trade-offs and the limitations of the pooled evidence.
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BibTeX
@article{hamodat2026antibioticbased,
title = {{Antibiotic-Based Nonoperative Management Versus Appendectomy for Uncomplicated Acute Appendicitis in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials}},
author = {Omar Hamodat and Sana Najjar and Alyamama Alnamous and Muhammed Ali Najah and Rama Karima and Deemah Al-Qaisi and Marwan Abdulkadder and Ahmad Holeihel},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15228910},
url = {https://www.mdpi.com/2077-0383/15/22/8910},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Antibiotic-Based Nonoperative Management Versus Appendectomy for Uncomplicated Acute Appendicitis in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
AU - Omar Hamodat
AU - Sana Najjar
AU - Alyamama Alnamous
AU - Muhammed Ali Najah
AU - Rama Karima
AU - Deemah Al-Qaisi
AU - Marwan Abdulkadder
AU - Ahmad Holeihel
PY - 2026
DA - 2026/11/13
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15228910
UR - https://www.mdpi.com/2077-0383/15/22/8910
AB - Background/Objectives: Acute appendicitis is the leading cause of emergency abdominal surgery in children. Although appendectomy remains the standard treatment, antibiotic-based nonoperative management (NOM) is an alternative for selected patients. We performed an updated systematic review and meta-analysis of randomized controlled trials (RCTs) comparing these strategies in pediatric uncomplicated acute appendicitis. Methods: PubMed, MEDLINE via Ovid, Scopus, and CINAHL were searched through 15 July 2026; CENTRAL and ClinicalTrials.gov were searched on 13 October 2026 (PROSPERO: CRD420261447254). Pediatric RCTs were included. RoB 2 and GRADE were used. Random-effects pooling required compatible outcomes. Results: Eight RCTs involving 1920 children were included. Both one-year comparative trials favored appendectomy, but their different composite endpoints were not pooled. NOM avoided appendectomy at one year in 62.5–70.0% in three trials. Clinical complications were uncertain (RR 1.61, 95% CI 0.63–4.13; I2 = 54.9%). No significant pooled difference was found in hospital stay or return to normal activities. Recurrence and school outcomes were reported separately. Conclusions: Appendectomy provides more reliable definitive treatment. NOM can avoid surgery in selected children but carries a risk of subsequent failure or recurrence. Comparative safety and recovery remain uncertain. Families should be informed of these trade-offs and the limitations of the pooled evidence.
SN - 2077-0383
ER -