ROLE OF CONSERVATIVE MANAGEMENT IN THE TREATMENT OF ACUTE UNCOMPLICATED APPENDICITIS

Original Article

Abstract

Background: This study aimed to evaluate the efficacy of conservative management as an alternative to surgery in treating acute uncomplicated appendicitis, a common surgical emergency worldwide.

Objectives: To evaluate the efficacy and safety of conservative management as an alternative to appendectomy in adults with acute, uncomplicated appendicitis.

Study Design: A Prospective Cross-Sectional Study.

Place and Duration of study: Department of Surgical Unit at Medical Teaching Institute/Mardan Medical Complex from May to October 2024

Methodology: This prospective cross-sectional study was conducted in the surgical unit at Medical Teaching Institute/Mardan Medical Complex from May to October 2024. Using non-probability convenience sampling, 140 patients were included, as determined by the OpenEpi sample size calculator (5% margin of error). Participants with acute, uncomplicated appendicitis (Alvarado score > 5) were identified through clinical history, physical examination, and laboratory tests. Exclusions included patients with recurrent appendicitis or complicated cases involving perforation, abscesses, or peritonitis.

Results: A total of 140 patients with acute uncomplicated appendicitis were included in the study, comprising 83 (59.3%) males and 57 (40.7%) females. The age distribution was as follows: <20years (8.6%), 20–30 years (47.9%), 31–40 years (30.7%), and >40 years (12.9%), with a mean age of 29.4 ± 7.9 years. The mean duration of symptoms at presentation was 13.9 ± 8.2 hours. All patients received intravenous antibiotics, analgesics, and fluids for at least 48 hours. Conservative management was successful in 87 (62.1%) patients, while 38 (27.1%) experienced treatment failure, and 15 (10.7%) had recurrent acute appendicitis.

Conclusion: Our study highlights the effectiveness of conservative management in acute, uncomplicated appendicitis, with a success rate of 62.1% achieved with intravenous antibiotics, analgesia, and fluids. At the same time, 27.1% of patients required surgery due to treatment failure, and 10.7% experienced recurrence; most avoided immediate surgical intervention. This approach not only proves clinically effective but also offers substantial cost benefits.