World J Surg (2017) 41:2411 DOI 10.1007/s00268-016-3864-8 LETTE R T O T HE EDI T OR Antibiotics Versus Appendicectomy for the Treatment of Uncomplicated Acute Appendicitis: An Updated Meta-Analysis of Randomised Controlled Trials by Rollins et al. 1 1 1 1 • • • J. C. Harnoss P. Probst M. W. Bu ¨ chler M. K. Diener Published online: 3 January 2017 Socie ´te ´ Internationale de Chirurgie 2016 Dear Editors, meta- and subgroup analyses revealed that treatment failure We read the article by Rollins et al.  with great of antibiotics occurred in 46.4% up to 1 year after the interest. This updated systematic review and meta-analysis initial hospital stay and the risk of complicated appendicitis is showing an intensive reﬂection of current debates and was signiﬁcantly increased by twofold . In conclusion, thus deserves a comment on results and its ﬁnal conclusion surgery represents a ﬁnal treatment with a clear risk proﬁle that antibiotics should be prescribed once a diagnosis of and important factors on antibiotic therapy are yet unin- acute appendicitis is made or considered and that the pri- vestigated (e.g. quality of life). Therefore, we plead for mary treatment of acute uncomplicated appendicitis should further RCTs and a transparent discussion of treatment be antibiotics. options, interdisciplinary and patient-oriented in cases with In our opinion , this conclusion is hastily and not suspected acute, uncomplicated appendicitis rather than a supported by current available data. The main general premature change of paradigm based on currently insufﬁ- critics are that we do not have any data about peri-inter- cient data. ventional quality of life of our patients and no follow-up of Compliance with ethical standards longer than one year after initial therapy. Moreover, adverse events of the antibiotic therapy were insufﬁciently Conﬂict of interest The authors declare that they have no conﬂict of reported by most of trials. Besides the fact that the choice, interest. application form, dosage and treatment duration of antibi- otics are unclear, we should be aware of the risk of sup- References porting antibiotic resistances and danger to treat malignancies with antibiotics if not performing a CT scan 1. Rollins KE, Varadhan KK, Neal KR et al (2016) Antibiotics versus which will have its own drawbacks. Furthermore, none of appendicectomy for the treatment of uncomplicated acute appen- the trials investigating antibiotics as primary therapy con- dicitis: an updated meta-analysis of randomised controlled trials. sidered repeating hospital stays as burden of this kind of World J Surg 40:2305–2318. doi:10.1007/s00268-016-3561-7 2. Harnoss JC, Zelienka I, Probst P et al (2016) Antibiotics versus treatment. surgical therapy for uncomplicated appendicitis: systematic review In accordance with our results, antibiotics may prevent and meta-analysis of controlled trials (PROSPERO 2015: 62.6–72.6% of patients from appendectomies [1, 2]. Nev- CRD42015016882). Ann Surg (epub ahead of print) ertheless, going one step further, thorough and proper & M. K. Diener email@example.com Department of General, Visceral and Transplantation Surgery and Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
World Journal of Surgery – Springer Journals
Published: Jan 3, 2017
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