Is routine appendicectomy always required after conservative treatment of appendicular lump

Abstract

Background: Routine appendicectomy following successful conservative treatment of appendiceal mass has been practiced since long. However the need of interval appendicectomy after conservative treatment of appendiceal mass in all cases remains controversial. Objective: To evaluate the justification of routine interval appendicectomy following successful conservative therapy of appendiceal mass.Material and Methods: This study was conducted at the department of general surgery, FAA Medical College, Barpeta, Assam. It was a descriptive study including all those patients who presented with appendicular mass from June 2017 to December 2019. These patients were treated conservatively as well as surgically. Patients who responded to conservative treatment were sent home and were followed for months for any recurrent attack. Patients who did not respond to conservative treatment, were explored after further investigation. Patients who had recurrent attack in the follow up were offered appendicectomy. Epi Info was used for  tabulation.Results: Total number of the patients included in the study was 463. Among them 62 patients has appendicular lump. Incidence was 13.3%. Most common age group was found to be 21 to 40 years . The study had female preponderance. A total of 9 patient from the group who did not respond to conservative treatment underwent exploratory laparotomy, drainage and appendicectomy at the same setting. 5 patients who had symptoms of recurrent appendicitis on follow up were further investigated and appendicectomy was done on confirmation of diagnosis. Conclusion: Conservative management is effective in most of the patients and routine interval appendicectomy after 6-week is controversial. Randomized control trial is needed to study the real need of interval appendicectomy.