Effectiveness of conservative management of uncomplicated acute appendicitis: A single hospital based prospective study

Abstract

Background: Acute appendicitis is one of the commonest causes of acute abdomen. There is a wide discussion and controversy on the surgical and nonsurgical treatment of acute uncomplicated appendicitis. The aim of this study was to evaluate the efficacy and outcomes of the conservative management of selected cases of acute appendicitis with an antibiotic first plan. Patients and methods: This was a single hospital-based prospective study with a duration of 25 months. Patients with clinical and radiological features of acute appendicitis presenting within 72 h of the beginning of abdominal pain with Alvarado score ≥5 were included. The patients received a therapeutic dose of broad-spectrum antibiotics and symptomatic treatment. The follow-up period was 6 months. Results: 90 patients were evaluated, 54 (60%) patients were female and 36 (40%) patients were male with mean age 34.4 years. Conservative treatment was successful in 68 (75.6%) patients and failed in 22 (24.4%) patients. No mortality recorded in this study. The main complications which occurred in those patients who failed to respond to conservative treatment were perforated appendicitis (3 patients), appendicular abscess (3 patients) and appendicular mass (4 patients). Conclusion: Majority of cases of the first attack of uncomplicated acute appendicitis can be treated successfully by conservative treatment. However, conservative treatment demands precise communication, close monitoring and follow-up to recognize failure which needs to be treated immediately by surgery. Highlights:

Suspected appendicitis and COVID-19, a change in investigation and management—a multicentre cohort study

“…Non-operative management of appendicitis with antibiotic therapy is an alternative option that can be safely used in certain cases with close monitoring [ 11 ], although this remains controversial with concerns over the risk of recurrence [ 12 ]. At 5 years, 39% of patients initially managed non-operatively will have an appendicectomy due to recurrence or complication [ 13 ].…”

Methods of conservative antibiotic treatment of acute uncomplicated appendicitis: A systematic review

“…4–11,18–43 Reports were mostly from Europe, Asia, and the United States but also from Nepal, 22 Pakistan, 29 and Iraq. 31 These trials ranged in evidence grade from level II (RCT with negative criteria) to level V (case series) and included eight RCTs 4–11 (number antibiotic-treated, 791), four prospective comparative (117), 18–21 11 prospective noncomparative (1,318), 22–32 10 retrospective noncomparative studies (597), 33–42 and one randomized single-blind (patients only) trial comparing conservative antibiotic treatment to supportive care (121). 43…”

“…Thirty-three (97%) of 34 trials used ultrasound or computed tomography (CT) imaging to evaluate the diagnosis of appendicitis and exclude findings of complicated appendicitis 4,6–11,18–43 ; ultrasound was used exclusively in five pediatric trials, 30,33,36–38 three adult trials, 4,29,31 and one with children and adults. 22 Twenty studies (59%) specifically excluded patients with any abscess, 9,18–20,22,25–29,31,32,34,36–41,43 and three (9%) excluded patients with unspecified complicated appendicitis or mass.…”

“…Thirty-three (97%) of 34 trials used ultrasound or computed tomography (CT) imaging to evaluate the diagnosis of appendicitis and exclude findings of complicated appendicitis 4,6–11,18–43 ; ultrasound was used exclusively in five pediatric trials, 30,33,36–38 three adult trials, 4,29,31 and one with children and adults. 22 Twenty studies (59%) specifically excluded patients with any abscess, 9,18–20,22,25–29,31,32,34,36–41,43 and three (9%) excluded patients with unspecified complicated appendicitis or mass. 10,11,30 However, two (6%) included patients with a small abscess (i.e., <5 cm), 21,33 and eight (24%) either did not specify (with exclusion in some based on a maximum appendiceal diameter) 4–6,23,24,35,42 or included all patients with appendicitis while reporting subgroups.…”

Is laparoscopic appendicectomy safe in the hands of junior trainees in surgery?

“…The overall lifetime risk of developing acute appendicitis is 8.6% for males and 6.7% for females; the lifetime risk of appendicectomy is around 12% in males and 23% in females [1]. Despite emerging data on the possibility of managing many patients with acute uncomplicated appendicitis conservatively, appendicectomy is still considered as the mainstay of treatment in most settings in both complicated and uncomplicated cases [2]. There are open and laparoscopic techniques for appendicectomy.…”