LAUSR

Appendectomy is accepted as the standard treatment of acute appendicitis, but in complicated cases, the treatment of choice is not straightforward. In this prospective study, we compared failure rate, complications, and recurrence rate of three different approaches to complicated appendicitis. In a 5-year prospective cohort study, patients with appendicular phlegmon were studied in three groups based on the treatment protocols. Group A included patients who underwent an appendectomy; patients of group B were treated by interval appendectomy; and in group C, conservative management was performed without interval appendectomy. Data analysis was performed using SPSS version 11.5. In total, 3896 patients with acute appendicitis were admitted, and 127 patients with complicated appendicitis were treated. Fifty-four patients were excluded from the study. Differences in age, gender, weight, and duration of symptoms were not statistically significant in the three groups. In group A (N = 23), appendectomy was impossible in 4 patients and 5 patients experienced complications. In group B (N = 24), two patients underwent exploration and appendectomy. In another two patients, a recurrent episode of acute appendicitis with mild signs and symptoms occurred after discharge from the hospital. In group C (N = 25), three patients experienced a recurrent appendicitis. Interval appendectomy is not indicated in all patients and continuous non-operative management may be appropriate in some patients. As the epidemiology of colorectal cancer and inflammatory bowel diseases is different in Iran, we recommend other researchers to perform a cost-effectiveness analysis on colon and appendicular neoplasms workup after non-operative management of complicated appendicitis.