Nonoperative treatment versus appendectomy for uncomplicated acute appendicitis.

Abstract

To the Editor,We have read the article that is published by Kirkil et al. (1) with a great deal and interest. They have brought up nonoperative treatment of uncomplicated appendicitis versus appendectomy. Although nonsurgical treatment of acute appendicitis is an unsatisfied method for sur-geons we have analyzed the article particularly. We want to emphasize some subjects that must be explained.Appendicitis is one of the most common surgical dis-eases. The lifetime risk of the acute appendicitis is re-ported nearly 7% (2). Although nonoperative treatment of acute appendicitis looks like alternative to surgery it is not recognized by majority of surgeons. Nowadays laparoscopic appendectomy even single vs. multiple port is investigated.Apurva et al. reported the rate of diagnosis of appen-diceal adenocarcinoma who had previous diagnose as 3.1%. Although authors performed colonoscopy in suspected patients that must be in mind the success of colonoscopy with appendiceal malignancy is low. Also the criteria to perform colonoscopy are not well de-fined. As authors underlined; there is not enough data and study about this. In our opinion there must be cost analyze of operative versus nonoperative treatment of noncomplicated ap-pendicitis to support nonoperative treatment as an ef-fective method. Preoperative diagnosis, medical treat-ment, hospital charges during follow up period and in case of need unavoidable surgery compose the cumu-lative cost of nonoperative treatment of noncompli-cated appendicitis (3). Early noncomplicated acute ap-pendicitis has lower cost according to the complicated appendicitis. Effective surgery could prevent increase of hospital cost (4). However Kirkil et al. indicated that nonoperative treat-ment of noncomplicated acute appendicitis is an effec-tive treatment method we believe that a diagnostic al-gorithm must be used during diagnosis and treatment of acute appendicitis.