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

DOI: 10.23736/S0394-9508.18.04922-7


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

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