Background: Several studies have also evaluated the efficacy of initial medical management compared with initial surgical management strategies with regard to abscess resolution with variable results.
Objective: The aim of this study is to evaluate the efficacy of initial medical management compared with surgical management of Crohn's disease (CD)-related intra-abdominal abscesses.
Data sources: A comprehensive search of multiple databases (MEDLINE/PubMed, Cochrane databases, CINAHL, Scopus, and Google Scholar) was performed in August 2014.
Study selection: All studies on adults comparing initial surgical versus medical approaches to treat CD-related abscesses were included.
Main outcomes measured: The durability of abscess resolution and rate of stoma creation between the groups undergoing initial surgical versus medical approaches were compared.
Results: The pooled analysis of the nine studies including a total 603 patients showed an overall rate of abscess resolution were 56.6% in the medical group compared with 80.7% in the surgical group. There was over three-fold higher chance of achieving abscess resolution when an initial surgical strategy was used at the time of abscess diagnosis compared with the medical strategy (odds ratio 3.44, 95% confidence interval: 1.80, 6.58, P<0.001). The number needed to treat using the initial surgical approach to prevent a recurrent abscess was four patients.
Limitations: All included studies were retrospective case series with potential clinical confounders not fully accounted in the analysis.
Conclusion: Initial surgical management appears to be superior to medical management in patients with CD-related intra-abdominal abscesses. Though all the included studies in this meta-analysis were retrospective, this meta-analysis is likely the strongest level of evidence with regard to the management of CD-related abscesses, given that a randomized-control trial may not be feasible given the low rate of abscess development in CD.