EN
TÜRKÇE
Poster - 320
To drain or not to drain? A comprehensive systematic review and pairwise meta-analysis of post-appendectomy abscess management in children
Agata Grochowska 1, Ana Emília Carvalho de Paula 2, Fernando Estima Seabra Neto 3, Alexia Rosas 4, Zarpana Akbari 5, Vyronas Argyris 6, Halima Sah 7, Miguel Eduardo Rodriguez Rodriguez 8, Camila Santos Loor 9, Ashwin Pimpalwar 10
1 Faculty of Medicine, Medical University of Lodz, Poland
2 Health Sciences Institute, Federal University of Jatai (UFJ), Jataí, Brazil
3 Science and Health University Institute - Héctor Alejandro Barceló Foundation, Argentina
4 Department of Medicine, Federal University of Sergipe, Brazil
5 Kabul University of Medical Sciences, Afghanistan; USA
6 Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
7 Faculty of Medicine, Medical Doctor, Bahçeşehir University, Istanbul, Turkey
8 Department of General Surgery, Lincoln Medical Center, Bronx, NY, United States
9 Universidad Católica de Santiago de Guayaquil, Ecuador
10 Department of Pediatric Surgery, Bon Secours Mercy Health System, Richmond, VA, United States
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.