COMPARISON BETWEEN SURGICAL AND CONSERVATIVE TREATMENT FOR ACUTE APPENDICITIS: A SYSTEMATIC REVIEW (Atena Editora)

Abstract

Acute appendicitis is one of the main reasons for emergency abdominal surgery, culminating in appendectomy. However, articles on clinical trials and systematic reviews analyzing the non-surgical treatment of appendicitis have been published, indicating that it may be a viable option in uncomplicated cases. However, in practice, in Brazil, these cases are almost always treated surgically, which is one of the most frequently performed interventions in the emergency room. Thus, the objective was to verify whether conservative treatment for acute appendicitis can already be considered as a substitute for surgery in cases of uncomplicated acute appendicitis. A systematic review of the literature was carried out, whose research was carried out in clinical trials, published between 2017-2022, that compared results of surgical and conservative treatments for acute appendicitis. The databases were PubMed, SciELO and Virtual Health Library. Fifteen articles were selected, which revealed that there are still controversial results regarding conservative treatment, but that even so it is quite effective in certain cases. Even though some studies have shown high rates of recurrence, these did not exceed 50%. Therefore, more than 50% of surgeries that would have been unnecessary, whose treatment with antibiotics alone offered remission of the disease, were avoided. What can be observed is that in order to have better success rates with conservative management, it is necessary to establish more robust characterization parameters on the target population for this treatment. In that regard, it was observed that higher rates of recurrence are associated with the presence of appendicitis and severe pain reported by the patient at presentation. It is suggested that these characteristics be considered as exclusion factors for the option for conservative treatment. Because there are significant rates of recurrence, it cannot be said that the therapeutic approach is equivalent to appendectomy in treatment success, but rather that it is a viable option and that it must be considered.