Background:
Post-appendectomy intra-abdominal abscess (IAA) is a common and challenging complication in pediatric surgical practice. Traditional management favors drainage; however, recent studies suggest that conservative treatment with antibiotics may be equally effective in selected patients. This systematic review and meta-analysis aimed to compare conservative and interventional approaches in managing pediatric post-appendectomy abscesses.
Methods:
A systematic literature search was conducted in PubMed, Embase, and CENTRAL from inception to June 2025. Eligible studies included randomized or observational studies comparing drainage (surgical/percutaneous) with conservative management in children (0–18 years) with IAA following appendectomy. The primary outcomes were treatment success, abscess recurrence, and length of hospital stay. Data were pooled using random-effects models, and subgroup and sensitivity analyses were conducted.
Results:
Ten studies comprising 363 pediatric patients (152 interventional, 211 conservative) were included. No significant difference was observed in treatment success (RR = 1.00; 95% CI: 0.95–1.05) or abscess recurrence (RR = 0.99; 95% CI: 0.57–1.74). However, conservative management was associated with a significantly shorter hospital stay (mean difference = -3.4 days; 95% CI: -6.14 to -0.65; p = 0.02). Subgroup analyses, including triple antibiotic therapy, fever, and drainage modality, showed no superiority of one approach over another.
Conclusions:
Conservative management with antibiotics appears as effective as interventional drainage for post-appendectomy abscesses in clinically stable children and may reduce hospitalization. However, findings are limited by a serious risk of bias and confounding. High-quality, prospective, multicenter studies with standardized protocols are urgently needed to inform evidence-based management.
Keywords: appendectomy, abscess, children, conservative management, drainage, meta-analysis, antibiotics
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