Early Surgical Management of Appendicular Mass: Evaluation of Surgical Outcome in Selected Private and Government Hospitals, Bangladesh

Abstract

Background: Appendicular mass, a common occurrence in acute appendicitis (10% of cases), develops within 24-48 hours of symptom onset. Management strategies, including early appendectomy, non-operative management with or without drainage, and interval appendectomy, vary widely. This study aims to evaluate the outcomes of early surgical management and compare different surgical approaches. Methodology: This retroospective observational study was performed in different private and government hospital at Jamalpur, Manikgonj for a period of 8 years from January 2015 to December 2022. A total of 288 consecutive patients meeting eligibility criteria underwent open appendectomy within 24 hours of hospital admission due to appendicular lump diagnosis based on clinical or ultrasonographic findings. Two surgical techniques were employed: appendicectomy with generalized peritoneal toileting and appendicectomy with loco-regional peritoneal toileting All data were collected from hospital records. Follow-up records for a period of 2 weeks and at the end of 1 year were reviewed. Results: Patients had a mean age of 30.04 years, mostly male and under 30 years old. Appendicular lump with abscess was predominant (73.96%), along with perforated appendix and presence of pus (71.18% and 75.35% respectively). 68.75% underwent appendicectomy with loco-regional toileting, and 31.25% with generalized peritoneal toileting. Both groups were similar in demographics and perioperative findings, with common difficulties in localization and dissection (76.79% and 88.89% respectively). No bowel injuries occurred in the loco-regional toileting group. Postoperative complications were significantly lower in this group, especially superficial and deep wound infections (11.61% vs 16.67%, 2.53% vs 10%). Fecal fistula and incisional hernia were observed in the generalized peritoneal toileting group (1.11%, 2.22%). Operative time was notably shorter in the loco-regional peritoneal toileting group (92 minutes vs 65 minutes) Conclusion: Early appendicectomy allows for single-admission treatment, serving as an effective alternative to conservative therapy by significantly reducing hospital stays and expenses. Specifically, early appendicectomy with loco-regional peritoneal toileting demonstrates shorter operative times and lower post-operative complications compared to generalized peritoneal toileting, suggesting its favorable utility in managing appendicular mass and warranting further optimization in surgical strategies.