Comparison of treatment methods of appendiceal mass and abscess: A prospective Cohort Study

Abstract

BackgroundThe aim of our prospective study is to compare and analyze the results of two treatment methods of appendiceal mass and abscess: emergency surgery and conservative treatment with and without interval surgery.Materials and methods74 Patients with the diagnosis of appendiceal mass or abscess were enrolled in this study. The patients were assigned into two groups: the emergency surgery group and the conservative management group. The conservative management group was subdivided into two groups: interval surgery group and the ambulatory follow-up observation group without interval surgery. Several clinical characteristics were determined and compared between the groups. Among patients who underwent surgery, the surgical methods, operation time, postoperative hospitalization period, and post-surgical complications were analyzed. In the ambulatory follow-up observation group, recurrence of appendicitis was assessed.ResultsComparison of the emergency surgery group and interval surgery group revealed that the interval surgery group was characterized by shorter operation time (P = 0.008), a smallernumber of postoperative complications (P = 0.02) and also shorter postoperative hospital stay (P = 0.009). In the ambulatory follow-up observation group, recurrence of appendicitis developed in 3 (13%) patients. US or CT-guided PCD was performed in all 3 patients on the conservative treatment stage. Comparing the interval surgery and recurrent appendicitis groups revealed statistically significant difference: operation time (P = 0.04) as well as postoperative hospital stay (P = 0.04) were shorter in recurrent appendicitis group. In 3 (4.1%) patients, the cause of the appendiceal mass was caecal cancer (2 cases) and Crohn's disease.ConclusionConservative treatment without interval surgery seems to be the preferred method for treatment of appendiceal mass and abscess. Patients can be operated on only in case of recurrence of appendicitis. US or CT PCD of appendiceal abscess presents the risk-factor for the development of recurrence of appendicitis. CT and colonoscopy within 4–6 weeks after completing the conservative treatment is recommended to be performed in all patients.

What is the main problem in conservative management for complicated appendicitis? A systematic review

“…1 for the procedure of literature selection), of which 845 patients were treated surgically (group IO) and 756 patients were treated conservatively (group CM). A total of 4 randomized controlled studies (RCT) [20][21][22][23] were included, and 10 retrospective studies (RS) [24][25][26][27][28][29][30][31][32][33] were included. The literature information of major concern is shown in the following table (Table 1)…”

“…A total of 10 studies 21,22,[24][25][26][27]29,30,32,33 reported the occurrence of unplanned interventions during treatment in each group (Fig. 2.…”

“…3. D), among which there were 3 RCTS 20,21,23 , and 9 retrospective studies [24][25][26][27][28][29][30][31][32] . The summarized results showed that patients in the CM group had a lower incidence of incision infection than those in the IO group (OR = 2.733, 95%CI [1.243, 6.012], P = 0.01 < 0.05).…”

“…With wound infection as indicators, Egger method was used to indicate the existence of publication bias (P = 0.001 < 0.1), and P = 0.464 > 0.05 after the use of metatrim method, suggesting the possibility of publication bias and the meta-analysis results of wound infection were not robust. Further analysis showed that in the four studies, percutaneous drainage was performed as required in the CM group (386 participants in the four studies [25][26][27]30 (Fig. 3.E).…”

“…The analysis results of operate time 27,28,32,33 ,overall complications 28,30 , intestinal fistula 21,25,26,28,29 , sepsis 23,25,26,31 , necrosis 23,25 , DVT 30,31 , pulmonary infection 30,31 are shown in Table 2.…”