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Is Interval Appendectomy Necessary for Appendicular Phlegmon? A Prospective Study

  • Mohammad Reza Motie
  • Ali Ahmadabadi
  • Mohammad Vejdani
  • Alireza Rezapanah
  • Majid Khadem Rezaiyan
  • Mohammad Naser Shafiee
  • Armin Mahdiani
Original Article

Abstract

Appendectomy is accepted as the standard treatment of acute appendicitis, but in complicated cases, the treatment of choice is not straightforward. In this prospective study, we compared failure rate, complications, and recurrence rate of three different approaches to complicated appendicitis. In a 5-year prospective cohort study, patients with appendicular phlegmon were studied in three groups based on the treatment protocols. Group A included patients who underwent an appendectomy; patients of group B were treated by interval appendectomy; and in group C, conservative management was performed without interval appendectomy. Data analysis was performed using SPSS version 11.5. In total, 3896 patients with acute appendicitis were admitted, and 127 patients with complicated appendicitis were treated. Fifty-four patients were excluded from the study. Differences in age, gender, weight, and duration of symptoms were not statistically significant in the three groups. In group A (N = 23), appendectomy was impossible in 4 patients and 5 patients experienced complications. In group B (N = 24), two patients underwent exploration and appendectomy. In another two patients, a recurrent episode of acute appendicitis with mild signs and symptoms occurred after discharge from the hospital. In group C (N = 25), three patients experienced a recurrent appendicitis. Interval appendectomy is not indicated in all patients and continuous non-operative management may be appropriate in some patients. As the epidemiology of colorectal cancer and inflammatory bowel diseases is different in Iran, we recommend other researchers to perform a cost-effectiveness analysis on colon and appendicular neoplasms workup after non-operative management of complicated appendicitis.

Keywords

Appendicitis Complications Phlegmon Interval appendectomy 

Abbreviations

CT scan

Computed tomography

SD

Standard deviation

WBC count

White blood cell

Notes

Acknowledgements

The results described in this paper are part of a thesis submitted by the third author for a postgraduate degree in general surgery. The study was supported by the Vice Chancellor for Research of Mashhad University of Medical Sciences (Grant No. 89007). The authors gratefully acknowledge the contribution of Ms. M. Hassanpour in editing the manuscript.

Authors’ Contributions

Conception and design: Mohammad Reza Motie, Mohammad Vejdani, and Ali Ahmadabadi

Analysis/interpretation: Ali Ahmadabadi, Majid Khadem Rezaiyan, Alireza Rezapanah, and Mohammad Reza Motie

Data collection: Mohammad Vejdani, Mohammad Reza Motie, Ali Ahmadabadi, and Armin Mahdiani

Writing the article: Ali Ahmadabadi, Mohammad Naser Shafiee, Majid Khadem Rezaiyan, and Alireza Rezapanah

Critical revision: Mohammad Reza Motie, Mohammad Naser Shafiee, Ali Ahmadabadi, and Majid Khadem Rezaiyan

Final approval: Mohammad Reza Motie, Ali Ahmadabadi, Mohammad Vejdani, Alireza Rezapanah, Majid Khadem Rezaiyan, Mohammad Naser Shafiee, and Armin Mahdiani

Statistical analysis: Majid Khadem Rezaiyan

Obtained funding: Mohammad Reza Motie

Overall responsibility: Mohammad Reza Motie, Mohammad Vejdani, and Ali Ahmadabadi

Compliance with Ethical Standards

Ethics statement

This prospective cohort study was approved by the ethics committee of Mashhad University of Medical Sciences, Iran. An informed consent was obtained before recruiting for the study.

Conflicts of Interest

The authors declare that they have no conflict of interest.

Funding

This study was supported by the Vice Chancellor for Research of Mashhad University of Medical Sciences.

References

  1. 1.
    Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925CrossRefPubMedGoogle Scholar
  2. 2.
    Hoffmann J, Lindhard A, Jensen HE (1984) Appendix mass: conservative management without interval appendectomy. Am J Surg 148:379–382CrossRefPubMedGoogle Scholar
  3. 3.
    Samuel M, Hosie G, Holmes K (2002) Prospective evaluation of nonsurgical versus surgical management of appendiceal mass. J Pediatr Surg 37:882–886CrossRefPubMedGoogle Scholar
  4. 4.
    Blakely ML, Williams R, Dassinger MS, Eubanks JW 3rd, Fischer P, Huang EY et al (2011) Early vs interval appendectomy for children with perforated appendicitis. Arch Surg 146:660–665. doi: 10.1001/archsurg. 2011.6 CrossRefPubMedGoogle Scholar
  5. 5.
    Weiner DJ, Katz A, Hirschl RB, Drongowski R, Coran AG (1995) Interval appendectomy in perforated appendicitis. Pediatr Surg Int 10:82–85CrossRefGoogle Scholar
  6. 6.
    Oliak D, Yamini D, Udani VM, Lewis RJ, Vargas H, Arnell T, Stamos MJ (2000) Nonoperative management of perforated appendicitis without periappendiceal mass. Am J Surg 179:177–181CrossRefPubMedGoogle Scholar
  7. 7.
    Lugo JZ, Avgerinos DV, Lefkowitz AJ, Seigerman ME, Zahir IS, Lo AY et al (2010) Can interval appendectomy be justified following conservative treatment of perforated acute appendicitis? J Surg Res 164:91–94. doi: 10.1016/j.jss.2009.05.025 CrossRefPubMedGoogle Scholar
  8. 8.
    Deakin DE, Ahmed I (2007) Interval appendicectomy after resolution of adult inflammatory appendix mass—is it necessary? Surgeon 5:45–50CrossRefPubMedGoogle Scholar
  9. 9.
    Whyte C, Tran E, Lopez ME, Harris BH (2008) Outpatient interval appendectomy after perforated appendicitis. J Pediatr Surg 43:1970–1972. doi: 10.1016/j.jpedsurg.2008.04.014 CrossRefPubMedGoogle Scholar
  10. 10.
    Iqbal CW, Knott EM, Mortellaro VE, Fitzgerald KM, Sharp SW, St Peter SD (2012) Interval appendectomy after perforated appendicitis: what are the operative risks and luminal patency rates? J Surg Res 177:127–130. doi: 10.1016/j.jss.2012.03.009 CrossRefPubMedGoogle Scholar
  11. 11.
    Wright GP, Mater ME, Carroll JT, Choy JS, Chung MH (2015) Is there truly an oncologic indication for interval appendectomy? Am J Surg 209(3):442–446. doi: 10.1016/j.amjsurg.2014.09.020 CrossRefPubMedGoogle Scholar
  12. 12.
    Puapong D, Lee SL, Haigh PI, Kaminski A, Liu IL, Applebaum H (2007) Routine interval appendectomy in children is not indicated. J Pediatr Surg 42:1500–1503CrossRefPubMedGoogle Scholar
  13. 13.
    Raval MV, Lautz T, Reynolds M, Browne M (2010) Dollars and sense of interval appendectomy in children: a cost analysis. J Pediatr Surg 45:1817–1825. doi: 10.1016/j.jpedsurg.2010.03.016 CrossRefPubMedGoogle Scholar
  14. 14.
    Dixon MR, Haukoos JS, Park IU, Oliak D, Kumar RR, Arnell TD, Stamos MJ (2003) An assessment of the severity of recurrent appendicitis. Am J Surg 186:718–722 discussion 722CrossRefPubMedGoogle Scholar
  15. 15.
    Lai HW, Loong CC, Wu CW, Lui WY (2005) Watchful waiting versus interval appendectomy for patients who recovered from acute appendicitis with tumor formation: a cost-effectiveness analysis. J Chin Med Assoc 68:431–434CrossRefPubMedGoogle Scholar
  16. 16.
    St Peter SD, Aguayo P, Fraser JD, Keckler SJ, Sharp SW, Leys CM et al (2010) Initial laparoscopic appendectomy versus initial nonoperative management and interval appendectomy for perforated appendicitis with abscess: a prospective, randomized trial. J Pediatr Surg 45:236–240. doi: 10.1016/j.jpedsurg.2009.10.039 CrossRefPubMedGoogle Scholar
  17. 17.
    Myers AL, Williams RF, Giles K, Waters TM, Eubanks JW 3rd, Hixson SD et al (2012) Hospital cost analysis of a prospective, randomized trial of early vs interval appendectomy for perforated appendicitis in children. J Am Coll Surg 214:427–434. doi: 10.1016/j.jamcollsurg.2011.12.026 discussion 434-5CrossRefPubMedGoogle Scholar
  18. 18.
    Kumar S, Jain S (2004) Treatment of appendiceal mass: prospective, randomized clinical trial. Indian J Gastroenterol 23(5):165–167PubMedGoogle Scholar
  19. 19.
    Henry MC, Gollin G, Islam S, Sylvester K, Walker A, Silverman BL, Moss RL (2007) Matched analysis of nonoperative management vs immediate appendectomy for perforated appendicitis. J Pediatr Surg 42:19–23 discussion 23-4CrossRefPubMedGoogle Scholar
  20. 20.
    Rosen M, Chalupka A, Butler K, Gupta A, Odom SR (2015) Pathologic findings suggest long-term abnormality after conservative management of complex acute appendicitis. Am Surg 81(3):297–299PubMedGoogle Scholar
  21. 21.
    Kogut KA, Blakely ML, Schropp KP, Deselle W, Hixson SD, Davidoff AM et al (2001) The association of elevated percent bands on admission with failure and complications of interval appendectomy. J Pediatr Surg 36:165–168CrossRefPubMedGoogle Scholar
  22. 22.
    Nazarey PP, Stylianos S, Velis E, Triana J, Diana-Zerpa J, Pasaron R et al (2014) Treatment of suspected acute perforated appendicitis with antibiotics and interval appendectomy. J Pediatr Surg 49:447–450. doi: 10.1016/j.jpedsurg.2013.10.001 CrossRefPubMedGoogle Scholar
  23. 23.
    Kaminski A, Liu IL, Applebaum H, Lee SL, Haigh PI (2005) Routine interval appendectomy is not justified after initial nonoperative treatment of acute appendicitis. Arch Surg 140:897–901CrossRefPubMedGoogle Scholar
  24. 24.
    Ein SH, Langer JC, Daneman A (2005) Nonoperative management of pediatric ruptured appendix with inflammatory mass or abscess: presence of an appendicolith predicts recurrent appendicitis. J Pediatr Surg 40:1612–1615CrossRefPubMedGoogle Scholar

Copyright information

© Association of Surgeons of India 2017

Authors and Affiliations

  • Mohammad Reza Motie
    • 1
  • Ali Ahmadabadi
    • 1
  • Mohammad Vejdani
    • 2
  • Alireza Rezapanah
    • 3
  • Majid Khadem Rezaiyan
    • 4
  • Mohammad Naser Shafiee
    • 5
  • Armin Mahdiani
    • 6
  1. 1.Surgical Oncology Research CenterMashhad University of Medical SciencesMashhadIran
  2. 2.Mashhad University of Medical SciencesMashhadIran
  3. 3.Department of Surgery, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
  4. 4.Student Research Committee, Department of Community Medicine and Public Health, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
  5. 5.English Department, Faculty of MedicineMashhad university of Medical SciencesMashhadIran
  6. 6.Faculty of MedicineHormozgan University of Medical SciencesBandar AbbasIran

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