Introduction:
Management of appendicular mass is one of the controversial topics in general surgery. Emergency surgery, even though successful, is associated with complications and patient morbidity. On the other hand, traditional conservative management needs a second admission for surgery which increases the management cost. The present article intends to address this dilemma.
Methods:
The study group consisted of 50 inpatients with appendicular mass who were randomised to emergency surgery (Group I) or the Conservative approach (Group II). The Conservative group was further divided into the Interval appendectomy group (Group IIA) and Observation Group without surgery (Group IIB). Both the groups were observed regarding the type of surgery, operative timing, intraoperative findings and postoperative complications. The study's outcome was assessed regarding time to oral diet, rate of complications rate, length of hospital stay and re-admission in 30 days.
Results: Both the groups had a similar mean age (29 years) with a predominance of males. Emergency surgery was associated with increased operative time (p=0.19), intraoperative difficulty with dense adhesions, abscess and perforation of the appendix, and increased complication rate (40%) compared to the conservative group (p= 0.0723). Emergency surgery was associated with significantly more surgical site infections (p = 0.039). In the conservative group, there was increased hospital stay, duration of medications (p=0.0025), time to oral feed (p =0.001) and need for a second admission for surgery, adding to the surgery cost. There was no mortality in any of the groups during the study.
Conclusion
Management of patients with Appendicular mass needs to be individualised for better surgical outcomes. Emergency surgery for appendicular mass is the preferred method of management appendicular mass, provided the necessary surgical experience is available.
Key words: Appendicitis, Appendicular mass, Emergency operation, Conservative management
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