Non operative management of Acute Appendicitis- A Prospective Study.

Dr. Rakesh Kumar Verma; Dr. Surit Majumdar

Volume : VIII, Issue : XII, December - 2019

Non operative management of Acute Appendicitis- A Prospective Study.

Dr. Rakesh Kumar Verma, Dr. Surit Majumdar

Abstract :

BACKGROUND: Right lower quadrant abdominal pain is a common cause of Emergency department admission. Acute appendicitis is one of the commonest diagnosis in this setting. The natural history of acute appendicitis non–operatively treated with antibiotics remains unclear. In this prospective study, operative and non–operative management of acute appendicitis were evaluated regarding their safety and cost effectiveness. AIMS AND OBJECTIVE: The purpose of this study was to assess the feasibility, initial safety and efficacy, early and late success rate of non–operative treatment of confirmed acute uncomplicated appendicitis and to monitor the long–term follow–up of non–operated patients. METHODS AND MATERIALS: Selected Acute Appendicitis patients were enrolled in this prospective comparative study (Conservative or non–operative vs operative or surgical treatment). Conservative treatment was based on a ief gut rest (partial or complete) and antibiotic therapy (Initially parenteral and then followed up with oral antibiotic). 105 patients of AA were selected for study, as per inclusion criteria. They were offered the options of conservative and surgical treatment. 52 patients opted for and complied with conservative treatment; rest (53) declined and opted for surgery, so were operated (Laparoscopic/Open) and taken as controls. Enrolment in study was done from March 2015 to Feuary 2017 and they were further followed up for a period of 2 plus years. Secondary outcomes include hospital length of stay and cost, days of missed works and return to normal activity at home; and these were compared in both the groups (conservative vs. operative). RESULT: In non–operative group (52 patients), 4 patients (7.69 %) failed to respond satisfactorily and managed by appendectomy. 2 patients (3.85 %) developed appendicular lump in the course and they were also operated with interval appendicectomy, so 6 patients were considered as early failures (11.54%) with early success rate of 88.46%. Four patients experienced recurrent attacks of acute appendicitis (AA); in them, repeat conservative approach was not tried and they were managed with appendectomy. This ought down the Late success rate to 80.76%. In appendectomy group, 2 patients complained of persistent discomfort in right lower abdomen, five patients developed wound or port site infection and one patient developed incisional hernia. In non–operative group, hospital stays were shorter with lesser hospital costs and days of missed work and also statistically significant as compared to appendectomy group. CONCLUSION: This study confirms the feasibility, safety and optimum success rate of non–operative treatment of early AA in selected patients