Management of Appendicular Mass; Comparative Study between Different Modalities

Abstract

In spite of its commonality, there is no universal standard in the management of appendicular mass. This study is a prospective one, aiming at comparing the different modalities of management in terms of efficacy and safety. Over seven years, all patients presented with appendicular mass were involved in the study, where they were divided into four groups; conservative management with routine interval appendectomy (group A), conservative treatment without interval appendectomy as a routine (group B), operative interference at the initial admission (group C), & laparoscopic exploration (group D). The study assessed the efficacy, complications, difficulties encountered in operative groups, rate of recurrence, hospital stay, and durations of treatment. 169 cases were presented in this study. The conservative management was successful in about 88% patients Appendectomy was done in all patients of group A, C & D, and only 18% in group B need appendectomy, Appendectomy was done in two settings (drainage then appendectomy) in ~5% of group A, ~4% of group B, 14% of group C, and 27% of patients in group D. The hospital stay & duration of treatment were >2 folds more in conservative groups (A&B) than intervention groups (C&D). Difficulties in operations were reported more in intervention groups (c &d), where consultant was needed in all cases of group D, 2/3 of group B , and only 1/3 of group B & 7% in group A. There was no significant difference in operative difficulties between patient failed conservative measures and interventional group from the start (group C&D). The study concluded that; although there is a debate in the best modalities of treatment of appendicular mass, the conservative approach is still a quite effective & safe method of treatment, with no significant operative difficulties in failed group. The rate of recurrence after successful conservative management is low to justify interval appendectomy as a routine. CT & or colonoscopy is preferred to be done after relief of acute attacks to avoid missing another pathology. The laparoscopic approach seem to be promising, with early recovery as well as diagnostic superiority for a hidden pathology. It may become the best modality with the growing of the learning curve.