Fugazzola P, et al. - In view of the lack of agreement among surgeons regarding the optimal treatment of complicated acute appendicitis in children (CAA), researchers undertook this systematic review and meta-analysis including studies comparing non-operative management (NOM) with operative management (OM) in children with CAA. They subgrouped the studies between those analyzing mixed patients with CAA, those focusing on patients with appendicular abscess (AAb)/appendicular phlegmon (AP) and those focusing on patients with free perforated appendicitis (FPA). Fourteen studies with a total of 1288 patients were meta-analyzed. As per outcomes, treatment with NOM in children with AAb/AP leads to better outcomes in terms of complication rate and re-admission rate. Conversely, OM treatment leads to better outcomes in terms of complication rate and re-admission rate in children with FPA.