A Meta-analysis of Percutaneous Drainage Versus Surgery as the Initial Treatment of Crohn's Disease-related Intra-abdominal Abscess.

Abstract

Spontaneous intra-abdominal abscess formation is a common complication of Crohn's disease. Percutaneous drainage [PD] may avoid surgery and preserve bowel length, although there is no consensus on its efficacy as the initial treatment and the associated outcomes if unsuccessful. This study uses meta-analytical techniques to compare the outcomes of PD alone versus primary surgery for Crohn's-related intra-abdominal abscess. A comprehensive search for comparative studies examining the use of PD and surgery for spontaneous Crohn's-related intra-abdominal abscess was performed. Each study was reviewed and data extracted. Random-effects methods were used to combine data. There were six studies including a total of 333 patients that met the inclusion criteria. Surgery was performed initially in 184 patients, PD was performed in 149. Groups were similar in demographics and abscess characteristics. There was a significantly higher risk of abscess recurrence following PD (odds ratio [OR]: 6.544, 95% confidence interval [CI]: 1.783-24.010, p: 0.005]. The pooled proportion of PD patients requiring subsequent surgery was 70.7%. There was no significant difference between approaches in post-procedural complication rate [OR: 0.657, 95% CI: 0.175-2.476, p: 0.535], ultimate permanent stoma requirement [OR: 0.557, 95% CI: 0.147-2.111, p: 0.389] or length of hospital stay [difference in means: -1.006 days, 95% CI: -28.762-26.749, p: 0.943]. PD can avoid surgery in up to 30% of patients presenting with spontaneous Crohn's-related intra-abdominal abscesses. However, the suggested advantages over surgery in relation to complications and length of stay were not apparent. Further studies in this area are needed.