Conservative Management of Pediatric Patients With Appendicolith Appendicitis Versus Non-appendicolith Appendicitis: A Systematic Review and Meta-analysis

Introduction: Up to one-third of pediatric patients with acute appendicitis present with radiological evidence of appendicoliths. However, whether appendicolith presence influences prognosis under conservative management compared to non-appendicolith appendicitis remains uncertain. Methods: We systematically searched PubMed, Cochrane, Embase, and Web of Science databases for studies comparing pediatric appendicolith and non-appendicolith appendicitis managed conservatively with antibiotics, fluids, and percutaneous drainage. Outcomes included the initial success of conservative management and recurrence rates. A random-effects model was applied for all analyses. Results: Twelve observational studies with 814 patients were included. Of these, 282 (35 %) had appendicoliths, and 532 (65 %) did not. The average age ranged from 2 to 11 years, with follow-up between 1 week and 2 years. Overall, there is no significant difference in the initial success of conservative management was observed between the two groups (OR 0.70; 95 % CI 0.28-1.78; p = 0.46). Subgroup analysis revealed lower success rates for appendicolith-associated simple appendicitis (OR 0.42; 95 % CI 0.21-0.84; p = 0.01), but no difference in complicated appendicitis (OR 1.01; 95 % CI 0.24-4.31; p = 0.99). Recurrence rates were significantly higher in appendicolith appendicitis across both groups (OR 2.75; 95 % CI 1.05-7.20; p = 0.04). Conclusion: Appendicolith presence reduces conservative management success in simple appendicitis, supporting early appendectomy. Although appendicoliths do not predict treatment failure in complicated appendicitis, interval appendectomy may be advisable due to the higher recurrence risk in both groups. Type of Study: Meta-analysis and systematic review. Level of Evidence: Level I. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.