Comparative Study of Non-operative versus Operative Management of Appendicular Lump – A Retrospective Study

Original Article

  • Jayaprabhu Uttur Assistant Professor, Department of Surgery
  • Sanjay S Namadar Associate Professor, Department of Surgery
Keywords: Appendicitis, Conservative method, Karnataka, Lump, Morbidity, Mortality

Abstract

Background: Acute appendicitis is one of the most common acute surgical conditions of the abdomen and appendicular lump
is formed if treatment is delayed. There is no clear standardized approach to complicated appendicitis associated with abscess
or phlegmon. Hence, different therapy would be useful and cost effective.
Materials and Methods: Out of 60 patients classified into Group I – Emergency surgery group 19 (5/61) and Group II conservative
treatment – 41. (a) Surgery after certain time (II A). (b) Ambulatory follow-up (II B). (c) Underwent appendectomy (II C).
Results: Clinical manifestations of Group-I and Group-II were compared. Duration of symptoms was 6.68 in Group I and 9.58 in
Group-II. Body temperate in Group-I 38.1°C, Group-II 36.76°C Heart rate (pulse/min) 87.48 in Group-I, 85.73 in Group-II, WBC
count – 13.252 in Group-I, 132010 in Group-II size of abscess (cm) 4.40 in Group-I, 4.98 in Group-II. In surgical appendectomy 14
patients were in Group-I, 26 patients were in Group-II, ileostomy 04 were in Group-I ,3 were in Group-II, in right hemicolectomy
only 2 in Group-II, operation time 106.68 (min) in Group-I, 88.19 in Group-II post-operative complication 2 in Group-I, 5 in GroupII, post-operative hospital stay 9.48 in Group-II, 9.3 in Group-I.
Conclusion: Non-operative management of complicated appendicitis has more failure rates, increased hospital expenses,
and perhaps increased morbidity when compared to immediate surgical management of complicated appendicitis remains gold
standard and should be used in most patients.

Author Biographies

Jayaprabhu Uttur, Assistant Professor, Department of Surgery

Sri Nijalingappa Medical College, Bagalkot, Karnataka, India

Sanjay S Namadar, Associate Professor, Department of Surgery

Mata Gujri Memorial Medical College, Mata Gujri University, Kishanganj, Bihar, India

References

1. Addiss DG, Schaffer N, Flower BS, Tauxe RV. The
epidemidogy of appendicitis and appendectomy the United
State. Am J Epidemiol 1990;132:910-25.
2. Wijayanayaka T, Davidson J, Bütter A. Does size matter?
Correlation of ultrasound findings in children without
clinical evidence of acute appendicitis. J Pediatr Surg
2018;53:980-3.
3. St Peter SD, Aguayo P, Fraser JD, Keckler SJ, Sharp SW,
Leys CM, et al. Initial laparoscopic appendectomy versus
initial nonoperative management and interval appendectomy
for perforated appendicitis with abscess: A prospective,
randomized trial. J Pediatr Surg 2010;45:236-40.
4. Simillis C, Symeonides P, Shorthouse AJ, Tekkis PP. A
meta-analysis comparing conservative treatment versus
acute appendectomy for complicated appendicitis. Surgery
2010;147:818-29.
5. Ambjomsson E. Management of appendiceal abscess. Curr
Surg 1984;41:4-9.
6. Bagi P, Duebolm S. Nonoperative management of the
ultrasonically evaluated appendiceal mass. Surgery
1987;101:602-5.
7. Shipsey MR, Donnell BO. Conservative management’s
appendix mass in children. Ann R Coll Surg Engl 1985;67:23-4.
8. Liu K, Fogg L. Use of antibiotics alone for treatment of
uncomplicated acute appendicitis: A systematic review and
meta-analysis. J Emerg Med 2012;42:499-512.
9. Hale DA, Molloy RH, Pearl RH, Schutt DC, Jaques DP.
Appendectomy: A contemporary appraisal. Ann Surg
1997;225:252-61.
10. Nazarrey PP, Styllanos S, Velis E, Triana J, Diana-Zerpa J,
Pasaron R, et al. Veils-treatment of suspected acute
perforated appendicitis with antibiotics and interval
appendectomy. J Pediatr Surg 2014;49:447-50.
Published
2021-04-26
Section
Articles