Systematic Review Comparing Nonoperative Management to Surgical Treatment of Acute Appendicitis in the Presence of a Retained Faecolith

Export Objective: The main management of acute appendicitis has typically been appendicectomy rather than the nonoperative approach. Nonoperative management showcases fewer complications but comes with the risk of relapse that leads to conversion to surgery. Acute appendicitis is correlated to faecolith presence in 13%–16% of cases. There is a controversy regarding the failure of conservative treatment in the presence of faecolith. This systematic review is to study the success of conservative treatment in appendicitis with faecolith existence. Methods: The Population, Intervention, Comparison, and Outcome (PICO) framework was used. Population: Acute appendicitis with faecolith at any age or gender (excluding complicated appendicitis, cases with comorbidities, and appendicitis without faecolith). Intervention: Nonoperative treatment with antibiotics. Comparison: Surgical appendicectomy was compared to nonoperative management. Outcome: Complications that need intervention or surgery within one month are considered a failure. Results: Search through (PubMed, BMJ, Research Gate, Elsevier, and Google Scholar) collected 65 records. Records after duplicate removal were 58. Screened against title and abstracts were 58. Excluded after screening against title and abstract was 49 (no appendicitis in 2, no fecalith in 27, complicated in 8, guidelines without patients data in 11, and case reports in 1. Articles assessed for eligibility were 9. The final texts included in the systemic review were 9. The total number of patients was 2336. The patients included were 731. Data from 86 patients were not complete (excluded). Nonoperative treatment was in 381 patients, with success in 221 (58%) and failure in 123 (32.28%), lost to follow 37 (9.7%). Surgical treatment was in 264 patients, success in 242 (91.66%), and failure in 22 (8.3%). Conclusions: Surgical treatment of faecolith in acute appendicitis is more successful than nonoperative treatment. Nonoperative treatment was successful in 58% of patients, but surgical management had a success rate of 91.7%.