Conservative Management in Acute Appendicitis is it Superior to Surgery? A Retrospective Study

Abstract

To see the merits of the surgical treatment and hence to reaffirm the superiority of surgery in acute appendicitis. Background: Surgery was the treatment of choice for acute Appendicitis which was practised over centuries. During the last decade, there were some publications about the conservative management of uncomplicated acute Appendicitis in adults and its advantages over the surgery. And all that studies also states that there was recurrence of about 20-30 %. Methods: The data of patients that came to the surgical department with acute appendicitis and recurrent appendicitis during the period November 2020 to December 2021 were analysed. The patients treated with surgery alone were included in the study. Detailed history, laboratory investigations and radiological investigation including Ultrasonogram (USG) were analysed to differentiate acute and recurrent cases. From the data we could identify the number of both acute and recurrent cases. Hospital admissions, number of episodes for the recurrent treatment, loss of working days and other relevant data were collected from the patients. Results: There were 61 patients who were operated for appendicitis including both acute and recurrent cases in the period of 1 year in the COVID era. Among these 34 were acute appendicitis and 27 recurrent appendicitis. Male: Female ratio was 39:22. Our study shows that majority are male patients and the most numbers are in the age group 10-30 years comparable to the standard statistics. Our study shows that 44.26% (27) of the total cases (61) operated was recurrent appendicitis. The number of recurrent episodes varied from the period of 1 week to 2 years after conservative treatment". In them treatment also varied from outpatient to inpatient in different individuals. The advantage of less hospital stays and decreased morbidity of conservative treatment is lost with subsequent investigation and surgical treatment in those. All the patients who got operated on follow up had an uneventful post operative period. Conclusion: So conservatively managed patients had lost many working days and had economic loss compared to patients operated for acute appendicitis early. Early surgery in acute appendicitis actually decreased the cost and morbidity. Keywords: Acute appendicitis; Recurrent Appendicitis; Appendicectomy; Conservative treatment; Appendicular perforation.