|
Treatment of
Appendiceal Masses: What Is the Best Approach?
Mohamed Altabakh, Ashraf Elattar, Hamdy Elnashartawy,
Tamer Abd Elhafez
Department of General Surgery, Faculty of Medicine, Tanta
University, Egypt.
Tanta Med. Sc. J 2008; 3(3):96-100
Article type: Original article
Background/Aim: For appendiceal masses, various
treatment options are available. Commonly, the mass is treated
conservatively followed by interval appendectomy, six weeks later.
Other surgeons prefer immediate appendectomy following resolution of
the mass. Less commonly, the mass may be treated only
conservatively, without the need for appendectomy. No randomized
trials have been reported in the literature to point the best option
out. We conducted a prospective, randomized clinical trial to
compare these three commonly used options. PATIENTS & METHODS: Over
a three-years period (from June 1998 to May 2001), 60 patients with
appendiceal masses were randomly allocated to one of three groups:
Group A; patients in this group received initial conservative
therapy, followed by interval appendectomy six weeks later, Group B;
patients in this group received initial conservative therapy
followed, as soon as the appendiceal mass resolved, by appendectomy
during the same admission (early appendectomy). Group C; patients in
this group received conservative therapy only. Short-term outcome
measures included: operative time, operative difficulty, occurrence
of operative and postoperative complications, and the length of
hospital stay. The following long-term outcome measures were looked
at: number of follow up visits, presence of severe wound pain, scar
appearance, and recurrence of appendicitis in group C patients.
RESULTS: The presence of intra-abdominal adhesions and the need to
extent the wound, and thus elongating the operative time, were
significantly higher in group B in comparison with group A. In all,
six patients in group B had postoperative complications against none
in group A (p<0.05). Mean duration of hospital stay was
significantly shorter in group C. Group C patients had significantly
less follow up visits in comparison with the other two groups
(p<0.05). Five patients in group A and eight patients in group B
complained of severe wound-related pain (P>0.05). Two patients in
group A and five in group B expressed concern about the ugliness of
the appendectomy scar (p>0.05). Only 2 of the 20 patients in group C
developed recurrent acute appendicitis. CONCLUSIONS: In patients
with appendiceal masses, although interval appendectomy seems to be
a safer and more cost-effective approach, when compared to early
appendectomy, the conservative only approach promises even better
results. The small study size and the relatively short duration of
follow up in our study made it difficult to draw strict conclusions
in favor of the last approach.
ICID 871176
|