Treatment of acute appendicitis: Retrospective analysis

Česká verze

Authors: K. Menclová ¹; E. Traboulsi ²; A. Nikov ¹; L. Hána ¹; M. Rousek ¹ ; M. Ryska ¹
Authors place of work: Chirurgická klinika 2. LF Univerzity Karlovy a ÚVN – VFN Praha, přednosta: prof. MUDr. M. Ryska, CSc. ¹; Oddělení patologie ÚVN – VFN Praha, primář: MUDr. P. Hrabal ²
Published in the journal: Rozhl. Chir., 2016, roč. 95, č. 8, s. 317-321.
Category: Původní práce

Summary

Introduction:
Acute appendicitis is the most common cause of intra-abdominal emergency surgery worldwide. The approach to its treatment keeps changing. The number of acute appendectomies has been decreasing. Many patients are treated conservatively with success. Our study compares conservative and surgical treatment of acute appendicitis, including its complications in our department.

Methods:
We retrospectively analyzed the group of 117 patients hospitalized with the clinical diagnosis of acute appendicitis. We distinguished patients with complicated and uncomplicated appendicitis, and patients operated and treated conservatively. We evaluated complication rates and recurrences of the disease, respectively, in 1-year follow-up. The Student t test and Fisher’s exact test were used for the statistical analysis.

Results:
In 2012 we hospitalized 117 patients with acute appendicitis: 83 patients (71%) for uncomplicated and 34 (29%) for complicated appendicitis. 41% of patients with complicated and 13% with uncomplicated appendicitis (p=0.02) were treated conservatively. Conservative treatment or laparoscopic surgery, respectively, were used more often in women ( p≤0.001). There was no failure of conservative treatment. Perioperative morbidity was 13%. No patient died. 6 patients (24%) of the conservatively treated group were hospitalized in the subsequent year for recurrent problems. 4 (16%) were reoperated. The rate of negative appendectomy (negative pathological findings) was 11%. The hospitalization time was shorter in patients treated conservatively or using laparoscopy, respectively, compared to the group of patients undergoing appendectomy.

Conclusion:
In the modern era of available complementary examinations and a broad spectrum of antibiotics the conservative approach is favoured as a treatment of complicated appendicitis. Conservative treatment of uncomplicated appendicitis is an option, but not the method of choice. Routine elective appendectomy after successful conservative treatment is groundless. Laparoscopic appendectomy is associated with lower morbidity than open appendectomy. Despite the available tests and scoring systems the negative appendectomy rate remains high.

Key words:
appendicitis – appendectomy – laparoscopy – antibiotic treatment

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