ORIGINAL ARTICLE   

Chirurgia 2019 December;32(6):300-5

DOI: 10.23736/S0394-9508.18.04922-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Conservative treatment versus surgery for the first episode of acute appendicitis: retrospective analysis of 429 cases

Anestis A. CHARALAMPOPOULOS ¹ ✉, Kostantinos G. KOPANAKIS ², Nikolaos N. KOLIAKOS ¹, Ioannis K. DIMOPOULOS ¹, Frederich A. FARRUGIA ¹, Aphrodite G. KAROUTA ³, Dimitrios C. PAPACONSTANTINOU ¹, Anna A. PASPALLA ¹, Nikolaos I. ZAVRAS ¹

¹ Third Department of Surgery, Attikon University Teaching Hospital, Athens, Greece; ² Surgical Unit, Thebes General Hospital, Thebes, Greece; ³ Department of Radiology, Agia Olga-Konstantopoulio Hospital, Athens, Greece

BACKGROUND: Surgical treatment of acute appendicitis, albeit commonly applied, may be over-performed and not be associated with any benefit in many patients, compared with conservative treatment. Our study tries to determine patient’s characteristics, diagnostic procedures and results in a cohort of surgically and conservatively treated group of patients.
METHODS: A total of 429 patients who presented with first episode of acute appendicitis (234 males, 198 females, age range 15-88 years, mean age 31.3±14 years) were included in our study and received either surgical (N.=327) or conservative (N.=102) treatment.
RESULTSː Patients’ demographics did not differ between the two groups, yet patients more than 50 years old were mainly treated by surgery (P=0.0011). A total of 290 patients (88.7%) from the surgical group and 102 patients (100%) from the conservative group had uncomplicated acute appendicitis. Complication rate was 9.5% in the surgical group, statistically higher than in conservative group (P=0.001). The mean hospital stay was higher in the surgical than in the conservative group (6.4 vs. 4.5 days) (P=0.028).
CONCLUSIONS: Patients younger than 50 years, with local abdominal signs, early onset of symptoms and uncomplicated appendicitis, represent an excellent group of patients for conservative treatment. The majority of patients (88.7%), operated for appendicitis, had uncomplicated acute appendicitis and do not benefit from surgery, as they had similar characteristics and results with the conservatively treated group, adding a complication rate of 9.5% and prolonged in-hospital stay.

KEY WORDS: Appendicitis; Conservative treatment; Retrospective studies