A comparative international study on the management of acute appendicitis between a developed country and a middle income country.
BACKGROUND
In the past decade there has been an exponential increase in the use of Computerised Tomography (CT) imaging in the assessment of patients with acute appendicitis. The aim of this study was to compare management approaches and clinical outcomes of acute appendicitis in Sri Lanka and the United Kingdom.


METHODS
Data was collected prospectively from 400 patients referred to the General Surgical department with a differential diagnosis of acute appendicitis, 200 at University Kelaniya Sri Lanka (SL group), and 200 at University College London Hospital (UK group).


RESULTS
The groups were similar with respect to gender, but the SL group was younger. Preoperative work-up included ultrasound more commonly in SL patients, and CT more commonly in UK patients. More patients underwent appendicectomy in the SL group, however a laparoscopic approach was utilised more often in the UK group (50.5% vs. 11.9%). Post-operative complications were similarly represented in both groups, but re-admission occurred with greater frequency in the UK group (16.2% vs. 0%). Histologically confirmed appendicitis was seen in a significantly greater proportion of SL patients (93.1% vs. 79.8%). Multivariate analysis confirmed male gender, and diagnosis and treatment in Sri Lanka to be only factors significantly associated with positive appendicitis.


CONCLUSIONS
Expensive investigations such as CT do not appear to improve the diagnostic accuracy of appendicitis or prevent complications. This study suggests diagnostic and treatment algorithms in the SL hospital are more accurate and efficient in confirming appendicitis than those seen in the UK hospital under investigation.
Department of General Surgery, University College London Hospital, London, United Kingdom. Electronic address: sheraz_markar@hotmail.com.
Sheraz R
SR
Markar
Faculty of Medicine, University of Kelaniya, Sri Lanka.
Diluka
D
Pinto
Department of General Surgery, University College London Hospital, London, United Kingdom.
Marta
M
Penna
Department of General Surgery, University College London Hospital, London, United Kingdom.
Alan
A
Karthikesalingam
Faculty of Medicine, University of Kelaniya, Sri Lanka.
Bulathsinghalage Kalana Sandun
BK
Bulathsinghala
Faculty of Medicine, University of Kelaniya, Sri Lanka.
Kumaralingam
K
Kumaran
Department of General Surgery, University College London Hospital, London, United Kingdom.
Majid
M
Hashemi
Faculty of Medicine, University of Kelaniya, Sri Lanka.
Ranil
R
Fernando
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000379:methods* / Q000706:statistics & numerical data; D001064:Appendicitis / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D019049:Developed Countries; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013188:Sri Lanka / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
Appendicectomy; Appendicitis; Computerised tomography; Ultrasonography