Prospective evaluation of nonsurgical versus surgical management of appendiceal mass.
OBJECTIVE
Prospective evaluation was undertaken of surgical findings, complications, morbidity, and hospital stay between initial nonsurgical management versus early surgical intervention of an appendicular mass.


METHODS
A prospective, nonrandomized study was conducted of 82 consecutive patients (mean age, 6.9 +/- 3.3 years) presenting with an appendicular mass over a 5-year period. They were categorized as group 1, 58.5% (48 of 82) nonsurgically managed and an interval appendectomy performed at a mean period of 8.6 +/- 4.6 weeks and group 2, 41.5% (34 of 82) appendectomy at presentation.


RESULTS
An appendix was identified in all 82 patients in both groups at operation. In-group 1, recurrent episodes of abdominal pain necessitated interval appendectomy in 39.6% (19 of 48) patients at a mean 4.3 +/- 0.8 versus 11.5 +/- 3.7 weeks in 60.4% (29 of 48) who underwent scheduled interval appendectomy. Periappendiceal abscesses present at interval appendectomy in group 1 was (38 of 48) 79.2% versus 100% (34 of 34) at appendectomy in group 2. Adhesions at interval appendectomy in group 1 was 81.3% (39 of 48) versus 100% (34 of 34) at appendectomy in group 2. In-group 1, superficial wound infection was observed in 0 versus 4 wound infections in group 2. Overall morbidity rate between group 1 and group 2 was statistically significant (P <.05). Total mean hospital stay in group 1 was 13.2 +/- 1.5 versus 4.8 +/- 0.4 days in group 2. Of the 48-interval appendectomy specimens, 37 of 48 (77%) appendices had a patent lumen, and 11 of 48 (23%) showed fibrosis and obliteration of appendicular lumen. There was no correlation (r = 0.22) between the histopathologic findings and the interval between abscess treatment and interval appendectomy.


CONCLUSIONS
Early surgical intervention was beneficial over nonoperative management in this cohort of patients. Interval appendectomy is recommended after nonsurgical management of an appendicular mass.
Samuel
M
M
Department of Pediatric Surgery, Great Ormond Street Hospital for Children, St. George's Heath Care NHS Trust, London, England.
Hosie
G
G
Holmes
K
K
D000038:Abscess / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications*; D002429:Cecal Diseases / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D002648:Child; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D007430:Intraoperative Care; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D013492:Suppuration / Q000209:etiology / Q000517:prevention & control; D000267:Tissue Adhesions / Q000209:etiology / Q000601:surgery
D000900:Anti-Bacterial Agents