Department of General Surgery, Russells Hall Hospital, The Dudley Group NHS Foundation Trust, Russells Hall Hospital, Pensnett Road, Dudley, DY1 2HQ, UK.
Department of General Surgery, Sandwell & West Birmingham Hospitals, West Bromwich, B71 4HJ, UK.
Langenbecks Arch Surg. 2021 Aug;406(5):1341-1351. doi: 10.1007/s00423-020-02042-3. Epub 2021 Jan 8.
The safety and role of emergency (EA) versus interval appendicectomy (IA) for appendicular abscess and phlegmon remains debatable with no optimal strategy identified. The aim of this systematic review and meta-analysis is to evaluate outcomes of managing appendicular abscesses and phlegmon with emergency or interval appendicectomy.
We conducted a systematic search of electronic databases using key terms including 'appendicular abscess', 'appendicular phlegmon' and 'interval appendicectomy'. Randomised controlled trials and observational studies comparing the two management approaches were included. Operative time, post-operation complication, unplanned bowel resection, rate of surgical site infection, post-operative length of stay and overall mortality rate were evaluated.
We identified six studies (2 RCTs and 4 observational studies) with a total of 9264 patients of whom (n = 1352) underwent IA, and (n 7912) underwent EA. The EA group was associated with statistically significant unplanned bowel resection (OR 0.55, 95% CI [0.33-0.90], P = 0.02) and longer total operating time (MD - 14.11, 95% CI [- 18.26-- 9.96] P = 0.00001). However, the following parameters were compared for both EA and IA groups; there were no significant statistical differences: surgical site infection (OR 0.49, 95% CI [0.17-1.38], P = 0.18), post-operative intra-abdominal collection (RD - 0.01, 95% CI [- 0.04-0.01], P = 0.29), total length of hospital stay (MD 1.83, 95% CI [- 0.19-3.85], P = 0.08), post-operative length of hospital stay (MD - 0.27, 95% CI [- 3.66-3.13], P = 0.88) and mortality rate (MD - 0.27, 95% CI [- 3.66-3.13], P = 0.66).
Emergency operation for appendicular abscess and phlegmon may lead to a higher rate of reported morbidity when compared with interval appendicectomy. Although emergency appendicectomy performed for appendicular abscess and phlegmon is a feasible and safe operative approach, it is associated with significantly increased operative time and unplanned bowel resection (ileocolic and right hemicolectomies) compared to interval appendicectomy.
对于阑尾脓肿和蜂窝织炎，急诊（EA）与间隔期阑尾切除术（IA）的安全性和作用仍存在争议，尚未确定最佳策略。本系统评价和荟萃分析的目的是评估 EA 和 IA 治疗阑尾脓肿和蜂窝织炎的结果。
我们使用包括“阑尾脓肿”、“阑尾蜂窝织炎”和“间隔期阑尾切除术”在内的关键词对电子数据库进行了系统搜索。纳入比较两种治疗方法的随机对照试验和观察性研究。评估手术时间、术后并发症、非计划性肠切除、手术部位感染率、术后住院时间和总死亡率。
我们共确定了 6 项研究（2 项 RCT 和 4 项观察性研究），共纳入 9264 例患者，其中 1352 例行 IA，7912 例行 EA。EA 组与非计划性肠切除显著相关（OR 0.55，95%CI [0.33-0.90]，P=0.02），总手术时间也较长（MD -14.11，95%CI [-18.26--9.96]，P=0.00001）。然而，EA 和 IA 两组之间的以下参数比较无显著统计学差异：手术部位感染（OR 0.49，95%CI [0.17-1.38]，P=0.18）、术后腹腔内积液（RD -0.01，95%CI [-0.04-0.01]，P=0.29）、总住院时间（MD 1.83，95%CI [-0.19-3.85]，P=0.08）、术后住院时间（MD -0.27，95%CI [-3.66-3.13]，P=0.88）和死亡率（MD -0.27，95%CI [-3.66-3.13]，P=0.88）。
与间隔期阑尾切除术相比，对于阑尾脓肿和蜂窝织炎，急诊手术可能会导致更高的报告发病率。虽然对于阑尾脓肿和蜂窝织炎进行急诊阑尾切除术是一种可行且安全的手术方法，但与间隔期阑尾切除术相比，它与显著增加的手术时间和非计划性肠切除（回结肠和右半结肠切除术）相关。
