Conservative Management Of Acute Appendicitis: A Review

Abstract

Background: Acute appendicitis still ranks as one of the most common acute surgical emergencies and appendicectomy is still the most common surgical procedure performed worldwide. Over the last century, there has been no significant change in the management of this condition. The aim of this study is to evaluate the available literature in order to determine if the conservative management of acute appendicitis with antibiotics is safe, feasible and cost effective.Methods: A systematic literature search has enabled a thorough critical appraisal of retrieved studies. Seventeen studies were analyzed to determine rigor, reliability and validity. Results: Analysis of the included studies revealed a preponderance of support for the safety and feasibility of conservative management of acute appendicitis. However, there is paucity of evidence to bolster the conservative approach in terms of cost effectiveness. There was also conflicting evidence on the role of interval appendicectomy after conservative management. Presence of calcified appendicolith on CT or USS was regarded as a negative predictive factor for recurrence.Conclusion: It can be concluded that the conservative management of acute appendicitis is a feasible and safe treatment modality. Recurrent appendicitis is a potential drawback, but good patient selection can help overcome this. The risk of missing serious pathology is minimal but further studies are needed for a reasoned judgment on cost effectiveness to be made.