Comparison of conservative antibiotic management versus early appendectomy in uncomplicated acute appendicitis:  A retrospective comparative study.

Jitendra Kumar  Chaudhary; Anil  Kumar; Kavita  Tirkey; Dr Shital  malua

doi:10.51168/sjhrafrica.v7i3.2644

Autori

Jitendra Kumar Chaudhary Senior Resident, Department of General Surgery, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
Anil Kumar Senior Resident (Non-Academic), Department of Neurosurgery, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
Kavita Tirkey Senior Resident, Department of Paediatric Surgery, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
Dr Shital malua Professor & HOD, Department of General Surgery, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

DOI:

https://doi.org/10.51168/sjhrafrica.v7i3.2644

Cuvinte cheie:

Antibiotic, uncomplicated appendicitis, appendectomy, recurrence risk, hospital stay

Rezumat

Background

Acute uncomplicated appendicitis is one of the most common surgical emergencies. Although early appendectomy remains the standard treatment, conservative antibiotic therapy has emerged as an alternative for selected patients.

Objective

To compare the clinical outcomes of conservative antibiotic management versus early appendectomy in patients with uncomplicated acute appendicitis

Methods

This retrospective comparative study included 100 patients with imaging-confirmed uncomplicated acute appendicitis treated between January 2021 and December 2022. Fifty patients received conservative antibiotic therapy, while 50 underwent early appendectomy. Clinical outcomes, including treatment success, hospital stay, pain resolution, complications, recurrence, and patient satisfaction, were compared using appropriate statistical tests. A p-value <0.05 was considered statistically significant.

Results

The mean age of participants was 30.5 ± 8.6 years, and 58% were males. Initial treatment success was significantly higher in the appendectomy group than in the conservative group (98% vs. 82%; p=0.01). The mean hospital stay was significantly shorter with conservative treatment (2.8 ± 1.1 vs. 4.1 ± 1.5 days; p=0.002). Pain resolution within 48 hours occurred in 76% of patients receiving antibiotics and 88% undergoing appendectomy (p=0.18). Recurrence within one year occurred in 18% of conservatively treated patients, while postoperative wound infection occurred in 10% of surgical patients.

Conclusion

Conservative antibiotic therapy is a reasonable short-term treatment option for selected patients; however, early appendectomy provides higher definitive treatment success and eliminates the risk of recurrence.

Recommendation

Conservative management should be reserved for carefully selected patients after shared decision-making, while early appendectomy remains the preferred definitive treatment.

Biografii autori

Jitendra Kumar Chaudhary, Senior Resident, Department of General Surgery, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

is a Senior Resident in the Department of General Surgery at Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India. His research interests include gastrointestinal surgery, emergency surgery, minimally invasive surgery, and clinical outcomes research.
Anil Kumar, Senior Resident (Non-Academic), Department of Neurosurgery, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

is a Senior Resident (Non-Academic) in the Department of Neurosurgery at Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India. His research interests include neurosurgery, trauma care, and evidence-based clinical practice.
Kavita Tirkey, Senior Resident, Department of Paediatric Surgery, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

is a Senior Resident in the Department of Paediatric Surgery at Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India. Her research interests include pediatric surgery, neonatal surgery, and clinical research.
Dr Shital malua, Professor & HOD, Department of General Surgery, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

is Professor and Head of the Department of General Surgery at Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India. His research interests include gastrointestinal surgery, laparoscopic surgery, surgical education, and clinical outcomes research.

Referințe

Talan DA, Saltzman DJ, Deugarte DA, Moran GJ, Angeles L. Methods of conservative antibiotic treatment of acute uncomplicated appendicitis : A systematic review. J Trauma Acute Care Sur. 2018;86(4):1-15. https://doi.org/10.1097/TA.0000000000002137

Chin X, Arachchige SM, Orbell-smith JL, Gandhi A. Conservative Versus Surgical Management of Acute Appendicitis : A Systematic Review. Cureus. 2024;16(1):1-10. https://doi.org/10.7759/cureus.52697

Mani V, Chejara R, Arya S V, Bhatia A, Chaudhary R, Raj M. Evaluation of conservative management in uncomplicated acute appendicitis. Int J Res Med Sci. 2021;9(9):2618-23. https://doi.org/10.18203/2320-6012.ijrms20213179

Gedam BS, Gujela A, Bansod PY, Akhtar M. Study of conservative treatment in uncomplicated acute appendicitis. Int Surg J. 2017;4(4):1409-16. https://doi.org/10.18203/2349-2902.isj20171152

Poprom N, Numthavaj P, Wilasrusmee C. The efficacy of antibiotic treatment versus surgical treatment of uncomplicated acute appendicitis : Systematic review and network meta-analysis of randomized controlled trial. Am J Surg [Internet]. 2019;218(1):192-200. Available from: https://doi.org/10.1016/j.amjsurg.2018.10.009

Xu H, Yang S, Xing J, Wang Y, Sun W, Rong L. Comparison of the efficacy and safety of antibiotic treatment and appendectomy for acute uncomplicated appendicitis : a systematic review and meta ‑ analysis. BMC Surg [Internet]. 2023;23(208):1-18. Available from: https://doi.org/10.1186/s12893-023-02108-1

Tarar B, Batool S, Majeed S, Saleem A. Comparison Between Early Appendectomy vs . Conservative Management in Cases of Appendicular Mass. Cureus. 2023;15(4):2-8. https://doi.org/10.7759/cureus.37986

Ahmad S, Ali K, Nasim A, Karim F. Comparison of Conservative versus Surgical Management of Acute Appendicitis in Terms of Hospital Stay. P J M H S. 2021;15(8):1927-30. https://doi.org/10.53350/pjmhs211581927

Paulina Salminen, Hannu Paajanen, Tero Rautio, Pia Nordström, Markku Aarnio, Tuomo Rantanen, Risto Tuominen, Saija Hurme, Johanna Virtanen, Jukka-Pekka Mecklin, Juhani Sand, Airi Jartti, ; Irina Rinta-Kiikka JMG. Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis The APPAC Randomized Clinical Trial. JAMA. 2016;313(23):1-9. https://doi.org/10.1001/jama.2015.6154