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Global Journal of Surgery 2012, 3: 18
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Research Article
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Does interval appendicectomy remain a suitable treatment option
in the era of laparoscopy?
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Sathyaprasad Burjonrappa
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Division of Pediatric Surgery, Department of Surgery, Maimonides Medical Center, 921 49th Street, Brooklyn NY, 11219, USA
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Abstract |
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Interval appendicectomy has been advocated for the treatment of acute appendicitis, with delayed presentation, particularly localized abscess or mass. Surgery in such cases is technically more difficult and may be more radical than necessary; increased risk of complications is a real potential. This issue has not been addressed in the current era of laparoscopy.
All patients with ICD codes 540.0 (ruptured) and 540.1 (abscess) admitted during 2011 were evaluated and those placed in the interval appendicectomy arm of management were subjects of this study. The treatment for these patients included antibiotics and/or drainage only at the first admission and surgery at a subsequent admission usually after 6 weeks from the initial presentation. Success was defined as planned appendicectomy at 6 weeks and failure was defined as appendicectomy prior to schedule due to complications. Demographics, physical examination findings, laboratory results, imaging studies, duration of admission, need for readmission, and complications were evaluated. Statistical analysis was performed by using Fisher exact test for categorical data and student t-test or Wilcoxson log rank test for continuous variables.
A total of 30 patients were placed in the interval appendicectomy arm during the study period. Interval appendicectomy strategy was successful in 18/30 cases (60%). In the successfully managed group the time to interval appendicectomy was on an average 68 days while in the unsuccessful group the time to appendicectomy was 22 days (p<0.0003). Age, sex, physical exam findings, white cell count, abscess size, gas in the abscess cavity, bowel obstruction on presentation, and presence of a fecolith was not significantly different in the successful and failed treatment groups. There was no difference in the total duration of hospital stay between the successful (14 days) and unsuccessful (18 days) groups.
The role of interval appendicectomy needs to be redefined in the current era of laparoscopy and 3rd- 4th generation of antibiotics. While some patients may benefit from this procedure, others have repeated hospital admissions and antibiotic induced complications that may precipitate a procedure sooner than planned, with no adverse consequences.
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Keywords |
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Appendicitis; Non-operative management; Appendix mass
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