Complicated appendicitis: Immediate operation or trial of nonoperative management? - 14/03/19
, Kazuhide Matsushima ⁎ , Alice Piccinini , Caroline Park , Aaron Strumwasser , Lydia Lam , Kenji Inaba , Demetrios Demetriades Abstract |
Background |
The optimal treatment for complicated appendicitis remains controversial. We sought to compare clinical outcomes of patients with complicated appendicitis treated with an immediate operation or a trial of nonoperative management.
Methods |
Adult patients (≥18 years) with complicated appendicitis were included. Patient characteristics and outcomes were compared between the immediate operation group and the nonoperative management group.
Results |
A total of 101 patients met our inclusion criteria. Of those, 36 patients received an initial trial of nonoperative management with an 86.1% success rate. Patients who failed nonoperative management required significantly longer hospital stays than those in the immediate operation group (11 vs. 5 days). An immediate operation was performed in 65 patients. Open surgery was required in 9 patients (13.8%). Postoperatively, 7 patients (10.8%) required percutaneous drainage of intraabdominal abscess.
Conclusions |
Nonoperative management was successful in the majority of patients with complicated appendicitis, whereas failure of nonoperative management was associated with prolonged hospital stay. Patients who underwent an immediate operation often required percutaneous drainage of intraabdominal abscess.
Il testo completo di questo articolo è disponibile in PDF.Highlights |
• | Non-operative management for complicated appendicitis had a high (86.1%) success rate. |
• | Failure of non-operative management was associated with increased morbidity with prolonged hospital stays. |
• | Of patients who underwent immediate operation, many required post-operative CT (27.2%) and percutaneous drainage (10.8%). |
• | Patients managed non-operatively also had a high rate of percutaneous drainage (32.3%) but were able to avoid surgery. |
• | Successfully managed non-operative patients had the same hospital length of stay as those managed with immediate operation. |
Keywords : Complicated appendicitis, Nonoperative management, Immediate operation
Mappa
Vol 217 - N° 4
P. 713-717 - aprile 2019 Ritorno al numero
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