Acute Appendicitis: Still a Surgical Disease? Results from a Propensity Score‐Based Outcome Analysis of Conservative Versus Surgical Management from a Prospective Database

Abstract

Considering each outcome as part of a wide-angle analysis, the conservative management of acute appendicitis resulted to be safe and effective in the selected group of patients. In terms of failure rate, the medical treatment resulted to perform as effectively as surgical treatment, if negative appendectomy was excluded from failure, or better, when negative appendectomy was included in the definition of failure. A diminished length of stay during the first admission and a reduced number of lost work days were evident with a conservative approach. The comparison between medical and surgical treatment for acute appendicitis requires a change in perspective, from a spare 'effectiveness analysis' to a more thorough 'appropriateness analysis': in the present study, the conservative treatment showed to address the clinical requirements in terms of therapeutic appropriateness. Although acute appendicitis is considered a 'surgical disease', increasing evidence supports the effectiveness and safety of a conservative approach for selected groups of patients.

Antibiotics alone as an alternative to appendectomy for uncomplicated acute appendicitis in adults: Changes in treatment modalities related to the COVID-19 health crisis

“…This therapeutic option was studied prospectively in the adult by several teams and the results were reported in six randomized clinical trials [4][5][6][7][8]10] and two non-randomized prospective studies [9,11]. Inclusion criteria were very similar between the different studies, i.e., adult patients who had a confirmed diagnosis of non-complicated acute appendicitis.…”

“…Non-complicated acute appendicitis involves approximately 40,000 patients/year in France [3] and constitutes a specific setting where a non-surgical alternative can be envisioned. In a report presented at the French Society for Gastro-Intestinal Surgery (Société française de chirurgie digestive (SFCD)) meeting in November 2019 (not yet published), surgical appendectomy was recommended in preference to medical treatment by antibiotics alone for the management of non-complicated acute appendicitis, mainly because the risk of recurrent appendicitis was found to range from 16% to 40% at one year after initial treatment [4][5][6][7][8][9][10][11]. However, the exceptional situation related to COVID-19 has led us to reconsider medical treatment alone for this particularly prevalent disease.…”

Waiting for the Second (Non)-Covid-19 Wave: Variations in Volume of Emergency Surgeries and of Emergency Department Accesses in a Third Level Hospital in Milan, Lombardy, During the Outbreak

“…If this is the case, and we can know it from statistics in the future, the medical community should revaluate the role of out-of-hospital medical therapies in treating diseases traditionally considered of surgical interest. Inhospital non-operative management (NOM) has been suggested by recent literature for uncomplicated appendicitis, selected cholecystitis patients and colonic diverticulitis [21][22][23][24][25][26][27]. In the COVID-19 era, this strategy was suggested by many international recommendations [28][29][30] and has many advantages, rst of all protecting patients and staff from possible intrahospital and in theatre virus transmission, save human resources and devices, and make new ICU beds available.…”

Comparing Appendectomy and Conservative Treatment for Patients with Uncomplicated Acute Appendicitis

“…Appendectomy, which is performed frequently both laparoscopic and open method in hospitals every day, include many risks since it is a surgical procedure, it is often applied under general anesthesia and it is a procedure that must be applied in urgent conditions. Although various complications such as perforation, intraabdominal abscess, and sepsis may develop in case of untreated or delayed diagnosis and treatment of acute appendicitis, patients with appendectomy may experience systemic problems caused by surgery or anesthesia such as appendicular leakage, bleeding, intraabdominal abscess, sepsis, wound infections, iatrogenic organ injury, incisional hernia [1,[6][7][8]. None of the complications such as perforation, sepsis, and intraabdominal abscess that may occur in delayed or not treated patients with acute appendicitis were seen in the antibiotherapy group.…”