Routine interval appendectomy is unnecessary after conservative treatment of appendiceal mass

Tekın, Ahmet; Kurtoğlu, Hi̇lal; Can, İlknur; Öztan, Şule

doi:10.1111/j.1463-1318.2007.01377.x

Cited by 72 publications

(40 citation statements)

References 14 publications

(58 reference statements)

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“…Failure of conservative management has been reported in 2-3% of cases with urgent exploration [17]. In our study, 10 [18]. According to the results of our study, most of the patients were managed successfully by conservative approach with only few needing surgery for complications.…”

Section: Methodssupporting

confidence: 60%

“…'Classical management' involves initial conservative management with broad spectrum antibiotics and intravenous fluid until the inflammatory mass resolves. Patients are offered interval appendicectomy 4-6 weeks later, believing that an early appendicectomy in these cases is hazardous, time consuming and may lead to life threatening complications such as fecal fistula [8][9][10]. Semi conservative approach involves performing immediate appendicectomy during the initial admission after resolution of the inflammatory mass or entirely conservative approach without interval appendicectomy.…”

Section: Introductionmentioning

confidence: 99%

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Appendicular Mass: A Conservative Approach

Koirala¹,

Thakur²,

Agrawal³

et al. 2016

J Nobel Med Coll

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IntroductionAppendicular mass is one of the most common complications following acute appendicitis and seen in 2-6% of the patients. The treatment of appendicular mass is controversial with three general approaches. The aim of this study is to evaluate outcome of conservative approach. Material & MethodsA retrospective analysis of the patients managed with appendicular mass from 1st January to 31 st December 2014 was carried out in NMCTH, Biratnagar. A total of 173 patients with diagnosis of appendicular mass admitted in emergency and OPD of our hospital were studied. All age groups and both sex were included. ResultsOut of 496 patients with appendicitis, 173 patients [34.87%] were diagnosed with appendicular mass. Age range of the patient in the study varied between 4-84 years and maximum patients found in the age group of 21-30 years. Onset of symptoms was between 2-6 days and greater number of patients reporting between 5-6 days. During study period 10(5.7%) patients came with recurrence, 9 [5.2%] developed abscess, 35(20.23%) patients came for interval appendicectomy, whereas 119 [68.78%] failed to come for a follow up. Conclusion Our study concluded that the appendicular mass can be managed successfully by conservative approach, although few complications may arise which can be managed by surgical intervention.

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Section: Methodssupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Appendicular Mass: A Conservative Approach

Koirala¹,

Thakur²,

Agrawal³

et al. 2016

J Nobel Med Coll

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“…6 For phlegmon, a number of treatment options ranging from conservative to aggressive approaches are available. We compared the three most popular approaches to the treatment of appendix mass.…”

Section: Discussionmentioning

confidence: 99%

“…Advocates of immediate appendicectomy mentioned advantages of avoiding the need for readmission for interval appendicectomy, and the exclusion of other pathologies masquerading as an appendix mass. [4][5][6][7] while advocates of interval appendicectomy described the advantages of avoiding recurrence of symptoms and the misdiagnosis of an appendix mass. 8,9 They argue that interval appendicectomy is a less hazardous and less challenging operation, compared with immediate appendicectomy during the initial admission.…”

Section: Introductionmentioning

confidence: 99%

Management of appendiceal mass

Garba

Ahmed

2008

Ann Afr Med

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Background:The management of appendiceal mass is surrounded with controversy. Traditional management has been conservative, with interval appendicectomy performed weeks after the mass had resolved. This remains the most common approach at many centers in the world. Recently, an increasing number of studies have challenged this approach. This article reviews some of the controversial issues in the management of appendix mass, assesses current practice and suggests an appropriate approach for the management of appendix mass. Methods: A Medline, Pubmed and Cochrane database search were used to find such key words and combinations of: appendix, appendiceal, appendicular, interval, appendectomy, appendicectomy, mass, abscess, phlegmon, and appendicitis. Results were saved and managed by Reference manager 11. All articles were cross-referenced by the authors. Results: A conservative management is still a highly acceptable approach for appendix mass. This should be followed with interval appendicectomy especially in patients with persistent right iliac fossa pain. Conclusion:We recommend initially conservative approach to the management of appendiceal mass especially in our environment. Keywords: Appendiceal mass, appendix abscess, appendix phlegmon, appendicitis, interval appendicectomyRésumé Contexte: La prise en charge du plastron appendiculaire est entoure de controverses. Le traitement usuel a toujours été conservateur avec l'appendicectomie réalisée plusieurs semaines après la fonte de la masse. C'est l'attitude la plus commune dans la plupart des centres à travers le monde. Récemment, un nombre croissant d'études ont conteste cette approche. Cet article passe en revue certaines controverses dans la prise en charge du plastron appendiculaire, présente les pratiques actuelles, et suggère une approche appropriée de la prise en charge du plastron appendiculaire. Méthode: Une recherche dans les bases documentaires Medline, Pubmed et Cochrane ont été faites par la recherche et la combinaison des mots clés que sont: appendice, appendiculaire, intervalle, appendicectomie, masse, abcès, phlegmon et appendicite. Les résultats ont été sauvegardes et traites a l'aide de Référence Manager 11. Tous les articles ont été recoupes par les auteurs. Résultats: Un traitement conservateur est encore une approche très acceptable pour le plastron appendiculaire. Cela devrait être suivi à distance par une appendicectomie particulièrement chez les patients ayant une douleur persistante de la fosse iliaque droite. Conclusion: Nous recommandons initialement une approche conservatrice pour la prise en charge du plastron appendiculaire particulièrement dans notre contexte.

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“…Moreover, recurrences are usually characterized by a milder clinical course than the primary attack [15] . Therefore routine interval appendicectomy is probably not warranted following successful management of uncomplicated AA, given the low risk of recurrent appendicitis and the potential early and late complications of an elective operation [8,[28][29][30] .…”

Section: Aa: Is It Necessary?mentioning

confidence: 99%

Interval routine appendectomy following conservative treatment of acute appendicitis: Is it really needed

Sakorafas¹

2012

WJGS

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Conservative management of acute appendicitis (AA) is gradually being adopted as a valuable therapeutic choice in the treatment of selected patients with AA. This approach is based on the results of many recent studies indicating that it is a valuable and effective alternative to routine emergency appendectomy. Existing data do not support routine interval appendectomy following successful conservative management of AA; indeed, the risk of recurrence is low. Moreover, recurrences usually exhibit a milder clinical course compared to the first episode of AA. The role of routine interval appendectomy is also questioned recently, even in patients with AA complicated by plastron or localized abscess formation. Surgical judgment is required to avoid misdiagnosis when selecting a conservative approach in patients with a presumed "appendiceal" mass.

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Routine interval appendectomy is unnecessary after conservative treatment of appendiceal mass

Abstract: Routine interval appendicectomy after initial successful conservative treatment is not justified and should be abandoned. At present, there is no consensus for the management of appendiceal mass. There is, therefore, a need to develop a protocol for the management of this common problem.

Cited by 72 publications

References 14 publications

Appendicular Mass: A Conservative Approach

Appendicular Mass: A Conservative Approach

Management of appendiceal mass

Interval routine appendectomy following conservative treatment of acute appendicitis: Is it really needed

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