Abstract
Background: Acute appendicitis is one of the commonest cause of acute abdomen. For more than 100 years, surgeons have been successfully performing appendectomy to treat acute appendicitis. However, there is a recent trend to shift towards a more conservative approach. There has been a wide discussion and controversy on the surgical and non-surgical treatment of acute uncomplicated appendicitis.
This work aimed to assess the effectiveness of non-operative conservative management in the treatment of acute uncomplicated appendicitis.
Method: This was a single tertiary care level hospital based study done within the duration from 1st September 2016 to 31st January 2018. 180 patients with clinical and radiological features of acute appendicitis presenting within 48 hrs of onset of the symptoms were enrolled. The patients received a broad spectrum antibiotic and symptomatic treatment. The patients were followed up for 6 months.
Results: Total 180 patients were enrolled. 108 (60%) of patients were female and 72 (40%) patients were males with mean age of 36 years. 144 (80%) patients successfully responded with the conservative treatment with antibiotics while 36 (20%) patients failed. No mortality was recorded in our study. Out of 36 patients who failed, 13 patients developed appendicular abscess, 12 patients had perforation of appendix while 11 patients had appendicular lump.
Conclusions: Conservative management can be established as the first line of management for uncomplicated acute appendicitis patients having first attack successfully, but it should be followed with close monitoring of patients.
References
- Mallik AA, Bari SU. Conservative management of acute appendicitis. J Gastrointest Surg .2009;13:966-970.
- 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 a early diagnosis. World J Surg. 2007;31:86-92.
- Subramanian A, Liang MK. A 60 years literature review of stump appendicitis: the need for a critical view. Am J Surg .2012;203:503-507.
- Fitz RH. Perforating inflammation of the vermiform appendix. Am J Med Sci. 1886;92:321-346.
- McBurney C. Experience with early operative interface in cases of diseases of the vermiform appendix. NY Med J. 1889;50:676-684.
- Gurin N, Slobodchuk Lu S, and Gavrilov Lu F. The efficacy of conservative management of patients with acute appendicitis on board ships at sea. Vestn Khir Im II Grek. 1992;148:144-150.
- Adams ML. The medical management of acute appendicitis in a non-surgical environment: A retrospective case review. Mil Med .1990;155:345-347.
- Bowers WF, Hughes CW and Bonilla KB. The treatment of acute appendicitis under sub-optimal conditions. US Armed Forces med J .1958;9:1545-1557.
- Foraker AG. A reluctant surgeon at sea. JAMA .1981;245:2302-2303.
- Campbell MR, Johnston SL 3rd, mashburn T et al. Nonoperative treatment of suspected appendicitis in remote medical care environments: Implication for future space flight medical care. J Am Coll Surg .2004;198:822-830.
- Ingraham AM, Cohen ME, Bilimoria KY, Ko CY, Hall BL, Russell TR et al. Effect of delay to operation on outcomes in adults with acute appendicitis. Arch Surg. 2010;145:886-897.
- Shindoh J, Niwa H, Kawai K, Ohata K, Isihara Y, Takabayashi N et al. Predictive factors for negative outcomes in initial non-operative management of suspected appendicitis. J Gastrointest Surg. 2010;14:309-314.
- Liu K, Fogg L. Use of antibiotics alone for treatment of acute appendicitis: A systematic review and meta analysis. Surg .2011;150:673-683.
- Mason RJ. Surgery for appendicitis: Is it necessary? Surg Infect Larchmt .2008;9:481-488.
- Sakorafas GH, Mastoraki A, Lappas C, Sampanis D, Danias N, Smyrniotis V et al. Conservative treatment of acute appendicitis: heresy or an effective and acceptable alternative to surgery. Eur J Gatroenterol Hepatol. 2011;23:121-127.
- Hansson J, Korner U, Khorram Manesh A, Solberg A, Lundholm K. Randomized clinical trial of antibiotic therapy versus appedectomy as primary patient of acute appendicitis in unselected patients. Br J Surg .2009 May;96(5):473-91.
- Hasson J, Korner U, Ludwings K, Johnsson E, Johsson C, Lundolhm K. Antibiotics as first line therapy for acute appendicitis: Evidence for a change in clinical practice. World J Surg.2012 Sep;36:2028-2036.
- Vaishnav U, Chauhan H. Evaluation of conservative management of acute appendicitis in tertiary care hospital. IAIM .2016 Feb;3:41-44.
- Vons C, Barry C, Maitre S, Pautrat K, Leconte M, Costaglioli B et al. Amoxicyllin plus clauvalanic acid versus appendectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomized controlled trial. Lancet. 2011;377:1573-1579.
- Horst JA, Trehan I, Warner BW, Coh BG. Can children with uncomplicated acute appendicitis be treated with antibiotics instead of appendectomy? Annals of Emergency Medicine. 2015 Feb;S0196-0644(15) 00085-2.
Corresponding Author
Dr C.K. Dutt
Associate Professor, Department of Surgery, G.R.M.C., Gwalior, MP, India
DOI: https://dx.doi.org/10.18535/jmscr/v6i9.10
