Outcome of early appendicectomy in appendicular mass versus conservative approach

ABSTRACT

The objectives of the study are to compare the outcome of early appendicectomy in appendicular mass versus conservative approach. Experimental Study. This study was carried out in Surgical Unit-IV, Liaquat University Hospital Hyderabad, from January 2008 to December 2009. This study consisted of hundred patients were divided in two groups. Group A for early appendicectomy and group B traditional conservative treatment, each group consist of 50 patients admitted through the outpatient department, as well as from casualty department of Liaquat University Hospital Jamshoro/Hyderabad. Data was analyzed through SPSS software. In conservative management [CM] group 36[72%] were male and 14[28%] female. Ratio malefemale ratio of 2.251. In immediate surgery [IS] group 34[68%] were male and 16[32%] female with malefemale ratio of 2.11. There was wide variation of age ranging from a minimum of 10 year to 50 year in both group. The mean age was 22.3 +/- 3.30 years for CM group and 23.4 +/- 3.50 years for IS group. Pain in right iliac fossa were found in all patients in both groups, vomiting was seen 42[84%] patients in CM group and 43[86%] patients in IS group, nausea was seen 17[34%] patients in CM group and 18[36%] patients in IS group, fever was 42[84%] patients in CM group and 44[88%] patients in IS group, diarrhea was 4[8%] patients in both groups, anorexia was seen 35[70%] patients in CM group and 37[74%] patients in IS group, constipation were 9[18%] patients in both groups and urinary complains was 8[16%] patients in CM group and 9[18%] patients in IS group. Ultrasound findings revealed was inflamed appendix with omentum adherent in 10[20%] patients of CM group and 9 [18%] patients of IS group where as inflamed appendix with omentum and abscess formation in 17[34%] patients of CM group and 19 [38%] patients of IS group, and edematous appendix with fecolith and omentum adherent in 23[46%] patients of CM group and 22[44%] patients of IS group. Operative time in both groups was recorded. Operative time range 30 minutes to 90 minutes in both groups. The mean time in CM group was 60.10 +/- 11.90 minutes and IS group was 45.30 +/- 7.96 minutes. The early appendectomy in appendicular mass is a safe alternate to conventional way of managing this problem. Hence, it obviates the need of a second admission and provides curative treatment during the index admission whereby minimizing total expenses