Journal of Surgery
Volume 4, Issue 2-1, March 2016, Pages: 27-30
Received: Oct. 11, 2015;
Accepted: Oct. 12, 2015;
Published: Jan. 27, 2016
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Emad Hokkam, Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt; Department of Surgery, Faculty of Medicine, Jazan University, Jazan, Saudia Arabia
Abdelaziz Gonna, Department of Surgery, Jazan General Hospital, Jazan, Saudia Arabia
Aly Saber, Department of Surgery, Port-Fouad General Hospital, Port-Fouad, Egypt
Ossama Zakaria, Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt; Department of Surgery, Faculty of Medicine, King Faisal University, Saudia Arabia
Abdulhameed Alhazmi, Department of Surgery, Faculty of Medicine, Jazan University, Jazan, Saudia Arabia
Background: For more than 100 years, surgeons have been successfully performing appendectomy to treat acute appendicitis. However; there is recent trend to shift towards a more conservative approach. This work aimed to assess the non- operative management in the treatment of acute uncomplicated appendicitis. Methods: One hundred and sixteen patients with uncomplicated acute appendicitis were enrolled into the study. They were divided into two groups (Group A & Group B). Patients in Group A were subjected to non-operative management with antibiotics while patients in Group B were subjected to appendectomy. All patients were evaluated at hospital discharge, at 30-days and at a median follow-up on year. The primary outcome was the success rate of the non-operative management. Secondary outcomes were the difference of length of hospitalization, time to return to normal activity, and quality-of-life measures between both groups. Results: The success rate of non-operative strategy was 93.3% (42 of 45) at hospital discharge, 88.8% (40 of 45) at 30-days and 82.2% (37 of 45) at a median follow-up of one year. Patients in Group A have a significantly shorter time to return to normal activities. They reported higher quality of life scores. The length of hospitalization was significantly shorter in Group B. Conclusion: Giving intravenous antibiotics to some patients with uncomplicated acute appendicitis instead of having them undergo surgery may be safe and effective.
Conservative Treatment Versus Appendectomy for Acute Uncomplicated Appendicitis, Journal of Surgery. Special Issue: Gastrointestinal Surgery: Recent Trends.
Vol. 4, No. 2-1,
2016, pp. 27-30.
Minneci PC, Sulkowski JP, Nacion KM, Mahida JB, Cooper JN, Moss RL, Deans KJ. Antibiotics alone as an alternative therapy for uncomplicated pediatric appendicitis. Journal of the American College of Surgeons. 2014 Oct; 219(4): 27.
Hennelly KE, Bachur R. Appendicitis update. Current Opinion in Pediatrics. 2011June; 23(3): 281–285.
Fitzmaurice GJ, Billy McWilliams B, Epanomeritakis E. Antibiotics versus appendectomy in the management of acute appendicitis: a review of the current evidence. Canadian Journal of Surgery. 2011 Oct; 54(5): 307-314.
Varadhan KK, Neal KR, Lobo DN. Safety and efficacy of antibiotics compared with appendectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomized controlled trials. BMJ. 2012 Apr 5; 344: e2156.
Andersson RE. The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis. World J Surg. 2007; 31: 86e92.
Varadhan KK, Humes DJ, Neal KR, Lobo DN. Antibiotic therapy versus appendectomy for acute appendicitis: a meta-analysis. World J Surg. 2010 Feb; 34(2): 199-209.
Ansaloni L, Catena F, Coccolini F, Ercolani G, Gazzotti F, Pasqualini E, Pinna AD. Surgery versus conservative antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized controlled trials. Dig Surg. 2011; 28(3): 210-21.
Wilms IM, de Hoog DE, de Visser DC, Janzing HM. Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database Syst Rev. 2011 Nov 9; (11): CD008359.
Mason RJ, Moazzez A, Sohn H, Katkhouda N. Meta-analysis of randomized trials comparing antibiotic therapy with appendectomy for acute uncomplicated (no abscess or phlegmon) appendicitis. Surg Infect (Larchmt). 2012 Apr; 13(2): 74-84.
Nagpal K, Udgiri N, Sharma N, Curras E, Cosgrove JM, Farkas DT: Delaying an appendectomy: is it safe? Am Surg 2012, 78(8): 897-900.
Vons C, Barry C, Maitre S, Pautrat K, Leconte M, Costaglioli B, Karoui M, Alves A, Dousset B, Valleur P, Falissard B, Franco D. Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. Lancet. 2011 May 7; 377(9777): 1573-9.
Sakorafas GH, Mastoraki A, Lappas C, Sampanis D, Danias N, Smyrniotis V. Conservative treatment of acute appendicitis: heresy or an effective and acceptable alternative to surgery? European journal of gastroenterology &hepatology. 2011 Feb; 23(2): 121-7.
Pinto F, Pinto A, Russo A, Coppolino F, Bracale R, Fonio P, Macarini L, Giganti M. Accuracy of ultrasonography in the diagnosis of acute appendicitis in adult patients: review of the literature. Crit Ultrasound J. 2013 Jul 15; 5 Suppl 1: S2.
Hansson J, Körner U, Khorram-Manesh A, Solberg A, Lundholm K. Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. Br J Surg. 2009 May; 96(5): 473-81.
Liu ZH, Li C, Zhang XW, Kang L, Wang JP. Meta-analysis of the therapeutic effects of antibiotic versus appendectomy for the treatment of acute appendicitis. ExpTher Med. 2014 May; 7(5): 1181-1186.
Shin CS, Roh YN, Kim JI. Delayed appendectomy versus early appendectomy in the treatment of acute appendicitis: a retrospective study. World J Emerg Surg. 2014 Jan 21; 9(1): 8.
Udgiri N, Curras E, Kella VK, Nagpal K, Cosgrove J. Appendicitis, is it an emergency? AmSurg 2011, 77(7): 898-901.
Papandria D, Goldstein SD, Rhee D, Salazar JH, Arlikar J, Gorgy A, Ortega G, Zhang Y, Abdullah F. Risk of perforation increases with delay in recognition and surgery for acute appendicitis. J Surg Res. 2013 Oct; 184(2): 723-9.
Minneci PC, Sulkowski JP, Nacion KM, Mahida JB, Cooper JN, Moss RL, Deans KJ. Feasibility of a non-operative management strategy for uncomplicated acute appendicitis in children. Journal American College of Surgeons. 2014; 219: 272e279.
Kirby A, Hobson RP, Burke D, Cleveland V, Ford G, West RM. Appendicectomy for suspected uncomplicated appendicitis is associated with fewer complications than conservative antibiotic management: A meta-analysis of post-intervention complications. Journal of Infection (2015) 70, 105e110.
Liu K, Fogg L. Use of antibiotics alone for treatment of uncomplicated acute appendicitis: a systematic review and meta-analysis. Surgery 2011; 150: 673e683.
Horst JA, Trehan I, Warner BW, Cohn BG. Can children with uncomplicated acute appendicitis be treated with antibiotics instead of an appendectomy? Annals of emergency medicine. 2015Feb 25. pii: S0196-0644(15)00085-2.
Shindoh J, Niwa H, Kawai K, Ohata K, Ishihara Y, Takabayashi N, Kobayashi R, Hiramatsu T. Predictive factors for negative outcomes in initial non-operative management of suspected appendicitis. J Gastrointest Surg 2010; 14: 309e314.
Ein SH, Langer JC, Daneman A. Non operative management of pediatric ruptured appendix with inflammatory mass or abscess: presence of an appendicolith predicts recurrent appendicitis. J Pediatr Surg 2005; 40: 1612e1615.