We want to share this Cochrane review: Early versus delayed appendicectomy for appendiceal phlegmon or abscess.

Objectives: The objective was to assess the effects of early appendicectomy compared to delayed appendicectomy on overall morbidity and mortality in people with appendiceal phlegmon or abscess.

Main results: Eight randomized trials with 828 participants were included.

For appendiceal phlegmon:

• Seven trials including 788 participants.
• There was no mortality in either group. 
• The evidence is very uncertain about the effect of early appendicectomy on overall morbidity, the proportion of participants who developed wound infections, and the proportion of participants who developed faecal fistulas.
• Early appendicectomy may reduce the abdominal abscess rate, reduce the total length of hospital stay by about two days, and increase the time away from normal activities by about five days, but the evidence is very uncertain.

For appendiceal abscess:

• One trial including 40 pediatric participants.
• There was no mortality in either group. The trial did not report on overall morbidity, various complications, or time away from normal activities. The evidence is very uncertain about the effect of early appendicectomy on the total length of hospital stay.

The authors concluded that for the comparison of early versus delayed open or laparoscopic appendicectomy for pediatric and adult participants with appendiceal phlegmon, very low‐certainty evidence suggests that early appendicectomy may reduce the abdominal abscess rate. For the comparison of early versus delayed laparoscopic appendicectomy for pediatric participants with appendiceal abscess, data are sparse, and we cannot rule out significant benefits or harms of early versus delayed appendicectomy.

Access publication here: https://doi.org/10.1002/14651858.CD011670.pub3