Must we do immediate appendectomy for acute appendicitis?

ABSTRACT

1. In a 2-year period starting January, 1970, we embarked on a program of delayed or semi-elective appendectomy for acute appendicitis. Sixty patients of the senior author were admitted with acute appendicitis but only 50 patients were finally selected to qualify for our study2. Regardless of the duration of illness or the time of admission, no immediate operation was done. Instead, the patient was scheduled for appendectomy not until the following day, included among the elective operations3. During this period before operation, the patient was prepared for elective surgery sparing the patient, the nursing and hospital staff and the surgical staff from unnecessary stress and strain of emergency procedure4. Antibiotics and intravenous hydration were among the principal preoperative preparations. Combination penicillin and streptomycin and also chloramphenicol were the antibiotics of choice5. In all cases the clinical diagnosis of acute appendicitis was confirmed at operation and on histopathological examination of the specimen. There was no single instance of perforation nor abscess6. No complication developed in any of the 50 patients who were all followed up for 30 days, at the minimum. There was no single fatality7. This study tends to justify a delayed or semi-elective approach to acute appendicitis. We also believe that this delayed surgical action with safety was mainly made possible by antibiotics among others. (Summary and Conclusions)