Evaluation of conservative management in uncomplicated acute appendicitis

Authors

  • Vignesh M. Department of Surgery, VMMC and Safdarjung hospital, New Delhi, India
  • Rajkumar Chejara Department of Surgery, VMMC and Safdarjung hospital, New Delhi, India
  • S. V Arya Department of Surgery, VMMC and Safdarjung hospital, New Delhi, India
  • Ankit Bhatia Department of Surgery, VMMC and Safdarjung hospital, New Delhi, India
  • Rohit Chaudhary Department of Surgery, VMMC and Safdarjung hospital, New Delhi, India
  • Monish Raj Department of Surgery, VMMC and Safdarjung hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20213179

Keywords:

Appendicitis, Treatment failure, Recurrence, Appendectomy, Alvarado score

Abstract

Background: Appendectomy has been the treatment for acute appendicitis for years based on the understanding that acute appendicitis always leads to perforation and peritonitis. However, there is growing evidence that a significant proportion of patients can be successfully managed with conservative treatment without developing gangrene or perforation. Conservative treatment avoids discomfort, surgery-related morbidities and minimizes treatment cost.

Methods: 60 patients taken up for conservative management were evaluated and followed up for 6 months. Study patients received intravenous antibiotics for 2 days. Repeated clinical and TLC monitoring were done. In patients whose clinical condition did not improve, appendectomy was performed. Follow-up at 10 days, 30 days, 3 months and 6 months were carried out to assess recurrence in conservatively managed patients.

Results: In this study, the mean age was 25.65 years with a standard deviation of ±8.96 years. The incidence of uncomplicated appendicitis was 63.3% in males and 36.7% in females. Mean Alvarado score was 7.75 with a standard deviation of ±1.20. Failure of conservative management (conversion to appendectomy) was observed in 11.7% of patients and 4 patients (6.6%) had recurrence within 6 months. The overall treatment efficacy was 81.7%.

Conclusions: In many cases, first attack of uncomplicated acute appendicitis can be treated successfully by conservative management. Treatment failure on primary admission as well as short-term recurrence up to six months after conservative treatment is low and acceptable. Incidence of complications like perforation and abscess formation are also statistically low.

References

Lewis FR, Holcroft JW, Boey J, Dunphy E. Appendicitis. A critical review of diagnosis and treatment in 1,000 cases. Arch Surg. 1975;110(5):677-84.

Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910-25.

Buckius MT, Grath B, Monk J, Grim R, Bell T, Ahuja V. Changing epidemiology of acute appendicitis in the United States: study period 1993-2008. J Surg Res. 2012;175(2):185-90.

Andreou P, Blain S, Du Boulay CE. A histopathological study of the appendix at autopsy and after surgical resection. Histopathology. 1990;17(5):427-31.

Chang FC, Hogle HH, Welling DR. The fate of the negative appendix. Am J Surg. 1973;126(6):752-4.

Arnbjornsson E, Bengmark S. Role of obstruction in the pathogenesis of acute appendicitis. Am J Surg. 1984;147(3):390-2.

Bhangu A, Soreide K, Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015;386(10000):1278-87.

Ergul E. Heredity and familial tendency of acute appendicitis. Scand J Surg. 2007;96(4):290-2.

Andersson RE. The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis. World J Surg. 2007;31(1):86-92.

You H, Sweeny A, Cooper ML, Von PM, Innes J. The management of diverticulitis: a review of the guidelines. Med J Aust. 2019;211(9):421-7.

Svensson JF, Hall NJ, Eaton S, Pierro A, Wester T. A review of conservative treatment of acute appendicitis. Eur J Pediatr Surg. 2012;22(3):185-94.

Sauerland S, Lefering R, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2002;(1):1546.

Wilms IM, Hoog DE, Visser DC, Janzing HM. Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database Syst Rev. 2011;(11):8359.

Coldrey E. Five years of conservative treatment of acute appendicitis. J Int Coll Surg. 2018;89(9):119-34.

Gedam BS, Gujela A, Bansod PY, Akhtar M, Singh K. Study of conservative treatment in uncomplicated acute appendicitis. Int Surg J. 2017;4:1409-16.

Hof KH, Lankeren W, Krestin GP, Bonjer HJ, Lange JF, Becking WB, et al. Surgical validation of unenhanced helical computed tomography in acute appendicitis. Br J Surg. 2004;91(12):1641-5.

Kalan M, Talbot D, Cunliffe WJ, Rich AJ. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg Engl. 1994;76(6):418-9.

Styrud J, Eriksson S, Nilsson I, Ahlberg G, Haapaniemi S, Neovius G, et al. Appendectomy versus antibiotic treatment in acute appendicitis. a prospective multicenter randomized controlled trial. World J Surg. 2006;30(6):1033-7.

Varadhan KK, Humes DJ, Neal KR, Lobo DN. Antibiotic therapy versus appendectomy for acute appendicitis: a meta-analysis. World J Surg. 2010;34(2):199-209.

Winn RD, Laura S, Douglas C, Davidson P, Gani JS. Protocol-based approach to suspected appendicitis, incorporating the Alvarado score and outpatient antibiotics. ANZ J Surg. 2004;74(5):324-9.

Andersson R, Hugander A, Thulin A, Nystrom PO, Olaison G. Indications for operation in suspected appendicitis and incidence of perforation. BMJ. 1994;308(6921):107-10.

Hansson J, Korner U, Manesh A, Solberg A, Lundholm K. Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. British J Surgery. 2009;96(5):473-81.

Turhan AN, Kapan S, Kutukçu E, Yigitbaş H, Hatipoglu S, Aygun E. Comparison of operative and non-operative management of acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2009;15(5):459-62.

Salminen P, Tuominen R, Paajanen H, Rautio T, Nordstrom P, Aarnio M, et al. Five-Year Follow-up of Antibiotic Therapy for Uncomplicated Acute Appendicitis in the APPAC Randomized Clinical Trial. JAMA. 2018;320(12):1259-65.

Harnoss JC, Zelienka I, Probst P, Grummich K, Lantzsch C, Harnoss JM, et al. Antibiotics Versus Surgical Therapy for Uncomplicated Appendicitis: Systematic Review and Meta-analysis of Controlled Trials (PROSPERO 2015: CRD42015016882). Ann Surg. 2017;265(5):889-900.

Podda M, Gerardi C, Cillara N, Fearnhead N, Gomes CA, Birindelli A, et al. Antibiotic Treatment and Appendectomy for Uncomplicated Acute Appendicitis in Adults and Children: A Systematic Review and Meta-analysis. Ann Surg. 2019;270(6):1028-40.

Yang Z, Sun F, Ai S, Wang J, Guan W, Liu S. Meta-analysis of studies comparing conservative treatment with antibiotics and appendectomy for acute appendicitis in the adult. BMC Surg. 2019;19(1):110.

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Published

2021-08-25

How to Cite

M., V., Chejara, R., Arya, S. V., Bhatia, A., Chaudhary, R., & Raj, M. (2021). Evaluation of conservative management in uncomplicated acute appendicitis. International Journal of Research in Medical Sciences, 9(9), 2618–2623. https://doi.org/10.18203/2320-6012.ijrms20213179

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Original Research Articles