Appendiceal abscess or phlegmon are traditionally managed by nonsurgical treatment and interval appendectomy.
This practice is controversial with proponents of immediate surgery and others questioning the need for interval appendectomy.
Dr Roland Andersson and colleagues undertook a systematic review of the nonsurgical treatment of patients with appendiceal abscess or phlegmon.
The researchers evaluated the success rate, need for drainage of abscesses, risk of undetected serious disease, and need for interval appendectomy to prevent recurrence.
|The risk of recurrence is 7% with nonsurgical treatment|
|Annals of Surgery|
The team identified 61 studies published between 1964 and 2005 reporting on the results of nonsurgical treatment of appendiceal abscess or phlegmon.
The results were pooled taking the potential clustering on the study-level into account.
A meta-analysis of the morbidity after immediate surgery compared with that after nonsurgical treatment was performed.
The researchers found appendiceal abscess or phlegmon in 4% of patients with appendicitis.
The team noted that nonsurgical treatment failed in 7%.
The need for drainage of an abscess was 20%.
Immediate surgery was associated with a higher morbidity compared with nonsurgical treatment.
After successful nonsurgical treatment, a malignant disease was detected in 1%, and an important benign disease in less than 1% during follow-up.
The researchers observed that the risk of recurrence was 7% with nonsurgical treatment.
Dr Andersson's team concluded, "The results of this review of mainly retrospective studies support the practice of nonsurgical treatment without interval appendectomy in patients with appendiceal abscess or phlegmon."