Evaluating conservative treatment for acute appendicitis with lump formation

Tu1575 Conservative Treatment and Interval Appendectomy for Acute Appendicitis

Acute appendicitis is one of the most common emergency abdominal disease, and recent studies have evaluated conservative treatment using antibiotics for uncomplicated appendicitis. Although the efficacy of conservative treatment for uncomplicated appendicitis is known, its efficacy for complicated appendicitis remains unknown, so are risk factors for the conservative treatment of appendicitis. In our institution, conservative treatment has long been the first choice for most appendicitis cases, except for perforation. Therefore, this novel study investigated the outcomes of conservative treatment for uncomplicated and complicated acute appendicitis and the risk factors associated with conservative treatment. To investigate the indication of conservative treatment by antibiotics for uncomplicated and complicated acute appendicitis. We investigated 270 patients who received conservative treatment for acute appendicitis at the Nishitokyo Central General Hospital, between April 2011 and February 2022. Twenty-eight (10.3%) patients were resistant to conservative treatment and underwent surgery. We retrospectively investigated the outcomes of conservative treatment for appendicitis and the risk factors for resistance to conservative treatment using the receiver operating characteristic curves and Cox hazard model. Two hundred and forty-two (89.7%) patients improved with conservative treatment. The significant and independent predictors of resistance to conservative treatment were body temperature ≥ 37.3 °C, appendicolith and Douglas sinus fluid visible on computed tomography (CT). The rate of resistance to conservative treatment was 66.7% (6/9) for patients with the above three factors, 22.9% (8/35) for patients with two factors (appendicolith and body temperature ≥ 37.3 °C), 16.7% (2/12) for patients with two factors (Douglas sinus fluid and appendicolith) and 11.1% (1/9) for patients with two factors (Douglas sinus fluid and body temperature ≥ 37.3 °C). A temperature ≥ 37.3 °C, appendicolith and Douglas sinus fluid on CT might be clinical risk factors of resistance to conservative treatment for acute appendicitis.

Watchful Waiting Versus Interval Appendectomy for Patients Who Recovered from Acute Appendicitis with Tumor Formation: A Cost-effectiveness Analysis

Appendectomy has historically been the standard treatment of acute appendicitis, but lately, conservative treatment of uncomplicated acute appendicitis with antibiotics has successfully been used in selected patients. Complicated acute appendicitis is often treated conservatively initially, but may benefit from interval appendectomy due to the higher risk of appendiceal malignancy and recurrence. Recommendations for follow-up after conservatively treated appendicitis vary. Furthermore, the risk of underlying malignancy and the necessity of routine interval appendectomy are unclear. This study aims to evaluate follow-up status, recurrence, and underlying appendiceal malignancy in conservatively treated uncomplicated and complicated acute appendicitis. This study included patients with conservatively treated acute appendicitis at Skåne University Hospital, Sweden during 2012-2019. Information on patient demographics at index admission and data on follow-up, recurrence, number of appendectomies after initial conservative treatment, and underlying malignancy were retrieved from medical charts. The study cohort included 391 patients, 152 with uncomplicated and 239 with complicated acute appendicitis. Median time of study follow-up was 52 months. The recurrence risk was 23 (15.1%) after uncomplicated and 58 (24.3%) after complicated acute appendicitis (p = 0.030). During follow-up, 55 (23%) patients with complicated acute appendicitis underwent appendectomy. Appendiceal malignancies were found in 12 (5%) patients with previous complicated acute appendicitis versus no appendiceal malignancies after uncomplicated acute appendicitis (p = 0.002). The risk of appendiceal malignancy and recurrent appendicitis was significantly higher in patients with complicated acute appendicitis compared with uncomplicated acute appendicitis.

Conservative management of acute appendicitis (AA) is gradually being adopted as a valuable therapeutic choice in the treatment of selected patients with AA. This approach is based on the results of many recent studies indicating that it is a valuable and effective alternative to routine emergency appendectomy. Existing data do not support routine interval appendectomy following successful conservative management of AA; indeed, the risk of recurrence is low. Moreover, recurrences usually exhibit a milder clinical course compared to the first episode of AA. The role of routine interval appendectomy is also questioned recently, even in patients with AA complicated by plastron or localized abscess formation. Surgical judgment is required to avoid misdiagnosis when selecting a conservative approach in patients with a presumed "appendiceal" mass.

The role of interval appendectomy (IA) after an episode of acute appendicitis is debated. Patients treated nonoperatively for acute appendicitis do not require routine IA. Retrospective cohort study using discharge abstract data. Twelve regional Kaiser Permanente hospitals in Southern California. A total of 32 938 patients were hospitalized with acute appendicitis. Appendectomy or nonoperative treatment with or without abscess drainage. Hospitalization for recurrent appendicitis or IA. The type of appendicitis was abscess in 7% of patients, peritonitis in 18%, and no peritonitis or abscess in 75%. Emergency appendectomy was performed in 31 926 (97%) patients. Nonoperative treatment was used initially in 1012 patients (3%). Of these, 148 (15%) had an IA and the remaining 864 (85%) did not. Thirty-nine patients (5%) recurred after a median follow-up of 4 years. Using Cox regression, sex had a slight influence on recurrent appendicitis (hazard ratio males vs females = 0.52, 95% CI, 0.27-0.99, P = .05). Age, Charlson comorbidity index, type of appendicitis, or percutaneous abscess drainage had no influence on recurrence. Median length of hospital stay was 4 days for the admission for recurrent appendicitis compared with 6 days for the IA admission (P = .006). Most patients with acute appendicitis undergo appendectomy initially. For those treated nonoperatively, the recurrence rate is low. Routine IA after initial successful nonoperative treatment is not justified and should be abandoned.

Background: An appendix mass is the result of a walled-off perforation of the appendix which localizes, resulting in a mass and it is encountered in up to 7% of patients presenting with acute appendicitis. The management of such problem is controversial. Immediate appendectomy may be technically demanding. Traditionally, management of these patients is conservative followed by interval appendectomy to prevent recurrence. However, the need for interval appendectomy has recently been questioned due to relatively small risk of recurrence. Also, there is still debate on adopting conservative management regarding the recurrence rate, the complication rate of interval appendectomy, and the potential for underlying malignancy. Our aim was to assess the preferred approach and current practice for management of acute appendix mass among surgeons in Al Taif Saudi Arabia.Methods: A questionnaire for the practice of surgeons in dealing with appendicular mass was designed and distributed to 21 consultants and 45 specialists.Results: 14.3% of consultant and 53.3% of specialist practiced the conservative management without routine interval appendectomy. Also, 14.3% and 26.7% of them respectively preferred immediate appendectomy while 71.4% of consultants and 20.0% of specialists did routine interval appendectomy. Most of the surgeons prefer to adopt the open method in immediate appendectomy while laparoscopic approach is the main adopting procedure for interval appendectomy. 57% of consultants stated risk of recurrence as the reason for performing interval appendectomy while, 53.4% of specialists would perform it to out-ruling neoplasm.Conclusions: Surgeons prefer to carry conservative approach with an interval appendectomy in management of appendix mass and laparoscopic approach for interval appendectomy. However immediate appendectomy and conservative management without interval appendectomy was preferred in other studies, which increase the necessity for national guidelines to be considered for management of this clinical condition.

The traditional management of appendiceal mass is initial conservative treatment followed by interval appendicectomy. Recently interval appendicectomy has been questioned by a growing amount of evidence. The purpose of this study was to clarify the role of interval appendicectomy after successful initial conservative treatment. The study included 98 patients with a mass in the right iliac fossa. Four (4%) patients were excluded wing to another diagnosis of appendiceal mass including caecal cancer (two), diverticulitis (one), and Crohn's disease (one). The remaining 94 patients were treated conservatively. Routine interval appendicectomy was not performed after successful conservative treatment. Ultrasound (US)-guided drainage was performed in seven (7.4%) patients. Two were drained surgically because of a persistent abscess despite a previous US-guided drainage. In five (5.3%) patients, a delayed operation was necessary because of complications. One patient developed small bowel obstruction, and in three patients, conservative treatment was unsuccessful with the abscess remaining unresolved. Within 3 months, seven out of the 89 patients were readmitted to hospital with a recurrent mass in two patients and acute appendicitis without a mass in five patients. Six (6.7%) patients were readmitted with recurrent appendicitis after 3 months. The recurrence rate after successful conservative treatment was 14.6%. The majority (nine patients; 10.1%) of the recurrences occurred within the first 6 months, and after 1 year the recurrence rate was very low (two patients; 2.2%). Routine interval appendicectomy after initial successful conservative treatment is not justified and should be abandoned. At present, there is no consensus for the management of appendiceal mass. There is, therefore, a need to develop a protocol for the management of this common problem.

Objective: To define the value of Tamsulosin drug addition to antibiotics (Ceftriaxone and Metronidazole) in conservative treatment of nonperforated acute appendicitis. Patients and methods: Prospective clinical study performed in Al-Jamhoory Teaching Hospital covering a period from Jan 2010 to Jan 2012. Formal consent from the patients and ethical approval were obtained. One-hundred and two patients including 74 males and 28 females, with age range of 17-45 years were admitted to the surgical unit number 3 complaining of acute appendicitis. Detailed clinical history was taken and clinical examination was carried out. All the patients had general urine examination (G.U.E), ultra sound (U.S) of the right iliac fossa and determination of serum c.reactive protein level. Those who had complicated appendicitis were excluded from the study. The patients were randomly divided into two groups A and B. Group A: Fifty one patients were given 500 mg of Ceftriaxone and 500 mg Metronidazole, both I.V twice daily. Group B: Fifty one patients were given the antibiotics regime plus Tamsulosin 0.4 mg orally once daily. The patients who had good signs of response (decrease or disappearance of the abdominal pain, tenderness and rebound tenderness and return of appetite) in the first 24 hours of the treatment continued the treatment for further 5 days, if there was no good response immediate appendicectomy was done. There was follow up of discharged patients for 4 months. Results: Group A: Forty-one patients out of 51 (80.39%) had a good signs of response (decrease or disappearance of the abdominal pain, tenderness and rebound tenderness and return of appetite) within the first 24 hours post presentation while 10 patients needed appendicectomy. Group B: Forty-nine patients (out of 51) 96.07% had good signs of response (decrease or disappearance of the abdominal pain, tenderness and rebound tenderness and return of appetite) within the first 24 hours post presentation and only 2 patients needed appendicectomy. Those who were discharged after conservative treatment were followed up for 4 months. Five patients in group A and 3 patients in group B had recurrence of symptoms and signs of acute appendicitis and appendicectomy was performed for them. Conclusion: Tamsulosin added to antibiotics for treatment of acute appendicitis is safe and resulted in speedy recovery of the patients with reduced recurrence of the condition. .

Acute appendicitis is one of the commonest surgical problems and appendectomy is one of the most commonly done operations in the emergency world wide. Though there have been occasional reports with conservative treatment in acute appendicitis, it is not being practiced as a routine. All patients between ten to sixty years of age admitted at BPKIHS with the diagnosis of acute appendicitis over a period of one year were enrolled in the study. After taking informed consent the patients were managed conservatively. Those who did not respond to antibiotics within 24 hours were operated. Total hospital stay and complications were recorded and they were followed up at first week, sixth week and sixth month. The success rate, conversion rate, recurrence rate and morbidity and mortality pattern were assessed as the final outcome of conservative treatment of acute appendicitis. A total of 96 patients (48 males and 48 females) underwent conservative treatment. The conservative treatment was successful in 79 (82.3%) cases and failed in 11 (11.4%) cases, which included: conversion to appendectomy during conservative treatment period 4 (4.2%) cases, recurrence 7 (7.3%) cases. There was no mortality in this study. Acute appendicitis can be treated successfully with conservative (antibiotics) treatment with a short hospital stay. Though there is a risk of recurrence in some cases, all the complications after appendectomy can be eliminated with the conservative treatment.

<p dir="ltr">Acute appendicitis is a clinical term for inflammation of the vermiform appendix with a sudden onset. Symptoms depend both on the age of a patient and on the position of appendix intraabdominally. The aetiology remains unknown, although, there are multiple theories. The lifetime risk of acute appendicitis in Western countries has been established as 7-8%, with 8.6% for males and 6.7% for females. The standard treatment has been surgery for many decades, but non-operative treatment, in the form of antibiotics, has more recently come to light as a feasible alternative to appendectomies.</p><p dir="ltr">Aims: The aim of this thesis was to assess intermediate and long-term outcomes of non- operative treatment in both children and adults. This included assessing safety and feasibility of non-operative treatment and its complications. An additional aim was to ascertain the failure rate of non-operative treatment and recurrence of acute uncomplicated appendicitis in children and try to establish the reasons for the treatment failure.</p><p dir="ltr">Methods: Study I was a 5-year follow-up of all participants who underwent surgery or non- operative treatment with antibiotics in a previous randomised controlled pilot trial. Data was extracted from the hospital notes and telephone interviews.</p><p dir="ltr">Study II was a long-term follow-up of adults with acute appendicitis who were involved in two randomised controlled trials, which compared non-operative treatment with appendectomy. The first trial consisted of 40 patients (13 female) and second trial was a multicentre study with 252 male patients. National registers were used to retrieve data at follow up, including the Swedish National Patient Register, the Cancer Register, the Cause of Death Register and Statistics Sweden.</p><p dir="ltr">Study III was a systematic review that was registered in PROSPERO (CRD42024592607) and done according to PRISMA statement. We searched three databases (PubMed, Medline, Web of Science). Eligible studies were randomised controlled trials or prospective cohort studies with children aged <18 years that received non-operative treatment for uncomplicated appendicitis and reporting at least 30 days follow-up. We carried out a meta- analysis.</p><p dir="ltr">Results: In Study I, we followed up all 50 children (26 children in the appendectomy group, 24 children in the nonoperative group) for at least 5 years. The surgical group was without failures and in the nonoperative group there were 11 failures and recurrences. In the first year there were nine failures, two of them had an appendicitis on the histopathology. Another two recurrences, that were histopathologically confirmed appendicitis occurred one to five years after the initial trial. At the 5-year follow-up, 54% of children had been successfully treated nonoperatively with antibiotics alone.</p><p dir="ltr">In Study II, in total, we were able to trace down 259 patients in the Patient Register, 137 patients in the non-operative group and 122 in the surgical group. At the end of follow-up, 82 (60%) patients had had successful non-operative treatment without an appendectomy. In the non-operative group there were 21 (15%) failures during the first admission. Thirty-four recurrences happened after discharge, all with a diagnostic code of acute appendicitis. After successful initial treatment, 82/116 (71%) remained without appendectomy.</p><p dir="ltr">In Study III, through a systematic search we were able to identify 2343 abstracts. Thirty studies were eligible, 8 randomised controlled trials and 22 prospective cohort studies reporting 27 different patient cohorts. An early failure rate occurred in 10% (95% CI 7-14%) and the recurrence rate was 29% (95% CI 24-34%) at the end of follow-up. When analysing studies with faecalith, a failure rate was higher (17% versus 6.4%) with P-value <0.0001.</p><p dir="ltr">Conclusions: Studies I and II demonstrated intermediate- and long-term safety of non- operative treatment alone in children and adults. This treatment does not increase the risk of malignancy and other complications and patients avoid surgery. Study III demonstrated a low initial failure rate and the recurrence rate was 29%. Non-operative treatment was less successful in children with a faecalith, particularly during first admission. These results can be used for discussion about treatment options of uncomplicated appendicitis with child patients and their caregivers.</p><h3>List of scientific papers</h3><p dir="ltr">I. <b>Patkova B</b>, Svenningsson A, Almström M, Eaton S, Wester T, Svensson JF. Nonoperative Treatment Versus Appendectomy for Acute Nonperforated Appendicitis in Children: Five-year Follow Up of a Randomized Controlled Pilot Trial. Ann Surg. 2020 Jun;271(6):1030-1035. <a href="https://doi.org/10.1097/SLA.0000000000003646">https://doi.org/10.1097/SLA.0000000000003646</a></p><p dir="ltr">II. <b>Pátková B,</b> Svenningsson A, Almström M, Svensson JF, Eriksson S, Wester T, Eaton S. Long-Term Outcome of Nonoperative Treatment of Appendicitis. JAMA Surg. 2023 Oct 1;158(10):1105-1106. <a href="https://doi.org/10.1001/jamasurg.2023.2756">https://doi.org/10.1001/jamasurg.2023.2756</a></p><p dir="ltr">III. <b>Patková B</b>, Svenningsson A, Jumah S, Wester T, Eaton S. Failure and recurrence of non-operative treatment of uncomplicated appendicitis in children; a systematic review and meta-analysis. [Manuscript]</p>

<p dir="ltr">Acute appendicitis is a clinical term for inflammation of the vermiform appendix with a sudden onset. Symptoms depend both on the age of a patient and on the position of appendix intraabdominally. The aetiology remains unknown, although, there are multiple theories. The lifetime risk of acute appendicitis in Western countries has been established as 7-8%, with 8.6% for males and 6.7% for females. The standard treatment has been surgery for many decades, but non-operative treatment, in the form of antibiotics, has more recently come to light as a feasible alternative to appendectomies.</p><p dir="ltr">Aims: The aim of this thesis was to assess intermediate and long-term outcomes of non- operative treatment in both children and adults. This included assessing safety and feasibility of non-operative treatment and its complications. An additional aim was to ascertain the failure rate of non-operative treatment and recurrence of acute uncomplicated appendicitis in children and try to establish the reasons for the treatment failure.</p><p dir="ltr">Methods: Study I was a 5-year follow-up of all participants who underwent surgery or non- operative treatment with antibiotics in a previous randomised controlled pilot trial. Data was extracted from the hospital notes and telephone interviews.</p><p dir="ltr">Study II was a long-term follow-up of adults with acute appendicitis who were involved in two randomised controlled trials, which compared non-operative treatment with appendectomy. The first trial consisted of 40 patients (13 female) and second trial was a multicentre study with 252 male patients. National registers were used to retrieve data at follow up, including the Swedish National Patient Register, the Cancer Register, the Cause of Death Register and Statistics Sweden.</p><p dir="ltr">Study III was a systematic review that was registered in PROSPERO (CRD42024592607) and done according to PRISMA statement. We searched three databases (PubMed, Medline, Web of Science). Eligible studies were randomised controlled trials or prospective cohort studies with children aged <18 years that received non-operative treatment for uncomplicated appendicitis and reporting at least 30 days follow-up. We carried out a meta- analysis.</p><p dir="ltr">Results: In Study I, we followed up all 50 children (26 children in the appendectomy group, 24 children in the nonoperative group) for at least 5 years. The surgical group was without failures and in the nonoperative group there were 11 failures and recurrences. In the first year there were nine failures, two of them had an appendicitis on the histopathology. Another two recurrences, that were histopathologically confirmed appendicitis occurred one to five years after the initial trial. At the 5-year follow-up, 54% of children had been successfully treated nonoperatively with antibiotics alone.</p><p dir="ltr">In Study II, in total, we were able to trace down 259 patients in the Patient Register, 137 patients in the non-operative group and 122 in the surgical group. At the end of follow-up, 82 (60%) patients had had successful non-operative treatment without an appendectomy. In the non-operative group there were 21 (15%) failures during the first admission. Thirty-four recurrences happened after discharge, all with a diagnostic code of acute appendicitis. After successful initial treatment, 82/116 (71%) remained without appendectomy.</p><p dir="ltr">In Study III, through a systematic search we were able to identify 2343 abstracts. Thirty studies were eligible, 8 randomised controlled trials and 22 prospective cohort studies reporting 27 different patient cohorts. An early failure rate occurred in 10% (95% CI 7-14%) and the recurrence rate was 29% (95% CI 24-34%) at the end of follow-up. When analysing studies with faecalith, a failure rate was higher (17% versus 6.4%) with P-value <0.0001.</p><p dir="ltr">Conclusions: Studies I and II demonstrated intermediate- and long-term safety of non- operative treatment alone in children and adults. This treatment does not increase the risk of malignancy and other complications and patients avoid surgery. Study III demonstrated a low initial failure rate and the recurrence rate was 29%. Non-operative treatment was less successful in children with a faecalith, particularly during first admission. These results can be used for discussion about treatment options of uncomplicated appendicitis with child patients and their caregivers.</p><h3>List of scientific papers</h3><p dir="ltr">I. <b>Patkova B</b>, Svenningsson A, Almström M, Eaton S, Wester T, Svensson JF. Nonoperative Treatment Versus Appendectomy for Acute Nonperforated Appendicitis in Children: Five-year Follow Up of a Randomized Controlled Pilot Trial. Ann Surg. 2020 Jun;271(6):1030-1035. <a href="https://doi.org/10.1097/SLA.0000000000003646">https://doi.org/10.1097/SLA.0000000000003646</a></p><p dir="ltr">II. <b>Pátková B,</b> Svenningsson A, Almström M, Svensson JF, Eriksson S, Wester T, Eaton S. Long-Term Outcome of Nonoperative Treatment of Appendicitis. JAMA Surg. 2023 Oct 1;158(10):1105-1106. <a href="https://doi.org/10.1001/jamasurg.2023.2756">https://doi.org/10.1001/jamasurg.2023.2756</a></p><p dir="ltr">III. <b>Patková B</b>, Svenningsson A, Jumah S, Wester T, Eaton S. Failure and recurrence of non-operative treatment of uncomplicated appendicitis in children; a systematic review and meta-analysis. [Manuscript]</p>

Introduction Conservative treatment of acute appendicitis is gaining popularity, and identifying patients with a higher risk of recurrence is becoming increasingly important. Previous studies have suggested that older age, male sex, diabetes, appendicolith and abscess formation may be contributing factors, however, results from the adult population are inconsistent. Aim This study aims to identify predictive factors for recurrent appendicitis after conservative treatment. Methods This retrospective study included patients with conservatively treated acute appendicitis at Skåne University Hospital, Sweden during 2012-2019. Information on patient demographics at index admission and follow-up data were retrieved from medical charts and radiologic images. Uni -and multivariable logistic regression analysis were performed using Stata Statistical Software. Results In total, 379 patients with conservatively treated acute appendicitis were identified, of which 78 (20.6%) had recurrence. All patients were followed-up for a minimum of 41 months after the first diagnosis of acute appendicitis unless appendectomy after successful conservative treatment or death occurred during follow-up. The median time to recurrence was 6.5 (1–17.8) months. After multivariable logistic regression analysis, external appendix diameter >10 mm [OR 2.4 (CI 1.37–4.21), p = .002] and intra-abdominal abscess [OR 2.05 (CI 1.18–3.56), p = .011] on computed tomography were significant independent risk factors for recurrent appendicitis. Appendicolith was not associated with an increased risk of recurrence. Conclusion This study suggests abscess formation and appendix distension of >10 mm to be potential risk factors for recurrent acute appendicitis after initial successful conservative treatment.

BackgroundInterval appendectomy is widely recommended for patients with abscesses due to perforated appendicitis. A concomitant malignancy-related problem was reported after conservative treatment of acute appendicitis with abscess, but perforated appendicitis-associated tuberculous peritonitis was never reported.Case presentationA 67-year-old male patient with a laryngeal cancer history presented to our hospital with an acute appendicitis-associated ileal abscess. He was scheduled for an interval appendectomy after conservative treatment. Fortunately, the symptoms subsided, and the patient was discharged for a later scheduled appendectomy. However, after 3 months, he was readmitted to our hospital with fever and abdominal pain, and emergency surgery was performed, which was suspected to be peritonitis. Intraoperative results revealed numerous white nodules in the abdominal cavity. The condition was diagnosed as tuberculous peritonitis based on macroscopic results, later pathological findings, and positive T-SPOT.TB. The antituberculosis medications were effective, and the patient recovered and was discharged from the hospital 8 days thereafter.ConclusionPatients, particularly those immunocompromised, may develop tuberculous peritonitis after conservative treatment for acute perforated appendicitis.

Objective: Acute appendicitis, as a common clinical acute abdominal condition, has a significant impact on patient prognosis depending on the choice of treatment strategy. This study aims to systematically compare the clinical efficacy and safety of surgical versus conservative treatment in patients with acute appendicitis. Methods: A total of 60 patients with acute appendicitis admitted to our hospital from August 2024 to July 2025 were selected as the study subjects and divided into a surgical group (n = 30) and a conservative group (n = 30) based on the treatment approach. The surgical group underwent abdominal incision appendectomy, while the conservative group received antibiotic therapy combined with symptomatic supportive treatment. Evaluation indicators included the treatment effective rate, symptom relief time, and complication incidence. Results: The treatment effective rate in the surgical group was 96.67%, significantly higher than that in the conservative group (76.67%) (p < 0.05). In terms of symptom relief, the time to relief of abdominal pain (1.25 ± 0.36 days) and fever (1.08 ± 0.29 days) in the surgical group was significantly shorter than that in the conservative group (3.12 ± 0.57 days and 2.89 ± 0.61 days, respectively, p < 0.001). The complication rates in the two groups were 10.00% and 13.33%, respectively (p > 0.05). Conclusion: Surgical treatment for acute appendicitis demonstrates significant advantages in improving treatment efficacy and shortening the time to symptom relief, with a comparable risk of complications to conservative treatment. It is therefore worthy of clinical priority recommendation, particularly for patients without surgical contraindications.