title: Late-presenting appendicitis: a laparoscopic approach to a complicated problem.
abstract: BACKGROUND
  Acute appendicitis is the most common abdominal condition necessitating urgent surgical intervention in the United States. The objective of this study was to determine if interval laparoscopic appendectomy after initial nonoperative treatment for late appendicitis presenting as an appendiceal mass is a safe alternative to immediate appendectomy.
  
  
  METHODS
  Thirty two consecutive patients (aged 16-74 years) during a 5-year period presented with appendiceal mass. Seventeen received initial nonsurgical treatment followed by interval laparoscopic appendectomy (aged 16-60 years; group 1). Fifteen underwent immediate appendectomy (aged 16-74 years; group 2).
  
  
  RESULTS
  All patients in the interval laparoscopic appendectomy group improved with initial therapy and underwent surgery an average of 4.9 months later. Although the operative time and the complication rate were similar between groups 1 and 2, the time to return to baseline activities was significantly less in group 1 after adjusting for age (p = 0.02 or less).
  
  
  CONCLUSIONS
  Interval laparoscopic appendectomy is safe in patients with chronic appendicitis and allows for judicious diagnostic evaluation of the appendiceal mass and planned surgery under controlled conditions.
authors.affiliation: Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA. ggibeily@aol.com
authors.forename: G J
authors.initials: GJ
authors.lastname: Gibeily
authors.forename: M N
authors.initials: MN
authors.lastname: Ross
authors.forename: D B
authors.initials: DB
authors.lastname: Manning
authors.forename: D C
authors.initials: DC
authors.lastname: Wherry
authors.forename: T-C
authors.initials: TC
authors.lastname: Kao
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D001063:Appendiceal Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D001064:Appendicitis / Q000188:drug therapy / Q000601:surgery* / Q000628:therapy; D002908:Chronic Disease; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors