Management of uncomplicated acute appendicitis during the COVID-19 pandemic: Appendectomy or non-surgical treatment?

BACKGROUND: This study aims to compare medical treatment and appendectomy in patients diagnosed with uncomplicated acute appendicitis during the COVID-19 pandemic.
METHODS: Retrospectively analyzed were the data of 80 patients who received medical or surgical treatment for uncomplicated acute appendicitis between March 15, 2020, and August 31, 2020. The demographic characteristics of the patients, length of hospital stay, physical examination and radiology findings, laboratory results, and any complications were recorded. Patients were divided into two groups depending on the mode of treatment, as surgical and non-surgical.
RESULTS: Forty patients were given medical treatment and 40 patients were directly operated on for appendicitis. Of the 40 patients who received medical treatment, 8 (20%) ended up requiring an operation due to recurrence. The mean duration of hospitalization was 2 days (range: 1–3), and the mean follow-up duration was 285.35±65.66 days (range: 101–379). The white blood cell count was significantly higher in the surgical group (p=0.004), and the length of hospital stay was longer in the non-surgical group (p<0.001). The prevalence of post-operative complications was similar for patients who underwent appendectomy directly on admission or after recurrence (p=1.000). Among the patients who received medical treatment, the most important predictors of requiring surgery were the red cell distribution width and increased appendix diameter in computed tomography (p<0.05).
CONCLUSION: Medical treatment is an effective alternative in patients with uncomplicated appendicitis. Even in the case of a recurrence in follow-up, surgery due to a potential recurrence is not associated with an increased rate of complication compared to direct surgery.

COVID-19 pandemi sürecinde unkomplike akut apandisit yönetimi: Appendektomi mi? nonoperatif tedavi mi?

AMAÇ: COVID-19 pandemi döneminde, unkomplike akut apandisit tanýlý hastalarda, týbbi tedavi ve appendektomi tedavisi karþýlaþtýrýlarak, hangi-sinin daha etkin bir tedavi yöntemi olduðunun ortaya konmasý amaçlandý.
GEREÇ VE YÖNTEM: Çalýþmada, 15.03.2020 ile 31.08.2020 tarihleri arasýnda, unkomplike akut apandisit nedeni ile cerrahi veya nonoperatif yöntem ile tedavi edilen 80 hastanýn verileri geriye dönük olarak incelendi. Hastalarýn demografik özellikleri, hastanede yatýþ süresi, fizik muayene ve radyolojik bulgularý, laboratuvar deðerleri, ameliyat edilenlerde komplikasyonlar kaydedildi. Hastalar, ameliyat edilenler ve nonoperatif tedavi edilenler þeklinde iki gruba ayrýlarak karþýlaþtýrýldý.
BULGULAR: Kýrk hastaya apandisit nedeni ile medikal tedavi verildi, 40 hasta ise direk olarak apandisit nedeni ile ameliyat edildi. Týbbi tedavi verilen hastalardan sekizi (%20) ikinci baþvuruda opere edildi. Hastalarýn yatýþ süresi iki (1–3) gün, ortalama takip süresi 285.35±65.66 gün (min: 101-maks: 379) idi. Yapýlan incelemede WBC deðerinin ameliyat olan grupta anlamlý olarak yüksek olduðu görülürken (p=0.004), yatýþ süresinin týbbi tedavi grubunda ameliyat grubuna göre daha yüksek olduðu tespit edildi (p<0.001). Hemen ameliyat edilenler ile ikinci baþvuruda ameliyat edilenler ara-sýnda, ameliyat sonrasý komplikasyonlar açýsýndan istatistiksel olarak fark izlenmedi (p=1.000). Týbbi tedavi sonrasý ikinci baþvuruda ameliyat olmayý belirleyen en önemli faktörler RDW deðeri ve bilgisayarlý tomografide apendiks çapýnda artýþ olduðu tespit edildi (p<0.05).
TARTIÞMA: Çalýþmada, unkomplike apandisit tanýlý hastalara medikal tedavi baþlanabileceði, daha sonraki takiplerinde nüks olsa bile, ikinci baþvuru-da yapýlan ameliyat ile komplikasyonlarýn artmayacaðý ortaya konmuþtur.