Outcome of Early Appendicectomy in Appendicular Mass Versus Conservative Approach

Abstract

Aim: The objectives of the study are to compare the outcome of early appendicectomy in appendicular mass versus 
conservative approach. 
Study Design: Experimental Study. 
Place and Duration of Study: This study was carried out in Surgical Unit-IV, Liaquat University Hospital 
Hyderabad, from January 2008 to December 2009. 
Materials and Methods: 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. 
Results: In conservative management (CM) group 36(72%) were male and 14(28%) female. Ratio male:female ratio 
of 2.25:1. In immediate surgery (IS) group 34(68%) were male and 16(32 %) female with  male:female ratio of 
2.1:1. 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. 
Conclusion: 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.