A prospective study on appendicular mass

Background: The immediate management of appendicular mass have always been controversial. Early appendicectomy (within 72 hours of presentation) is preferred in some cases, while in others non operative conservative management is advocated. Usually successful conservative management (Ochsner Sherren regimen) is followed by interval appendicectomy (6-8 weeks later). This study determines the outcome of different modalities of intervention in patients with appendicular mass.Methods: A prospective study was conducted in Rajah Muthiah medical college hospital in department of general surgery from June 2018 to December 2020, in cases diagnosed to have appendicular mass. A total of 116 patients were included. After taking detailed history and clinical examination, relevant blood and radiological investigations, were done to achieve the final diagnosis. Presentation, examination findings, investigations, type of surgery, duration of surgery, post-operative complications and duration of hospital stay were studied. Data was collected, compiled, tabulated and analysed.Results: Conservative management followed by interval appendicectomy had lesser incidence of complications like Intraoperative adhesions, surgical site infection, wound dehiscence and enterocutaneous fistula. It also had relatively lesser operative time and lesser period of hospital stay.Conclusions: On comparing the different modalities of intervention, conservative management followed by interval appendicectomy is quite effective and safe method of treatment, with less operative difficulties and better outcome.

A PROSPECTIVE COMPARATIVE STUDY BETWEEN EARLY AND INTERVAL APPENDICECTOMY FOR APPENDICULAR MASS

Acute appendicitis remains the most common cause of acute abdomen requiring surgical intervention. Patients presenting late in acute appendicitis are complicated by the development of an inammatory mass in the right iliac fossa. The treatment of appendicular mass is controversial. However, 1 there are several other management options for appendicular mass. Traditionally, these patients are managed conservatively, followed by interval appendicectomy 4-6 weeks later. Advocates of the initial conservative approach claim a lower rate of complications compared to the early 2 operative approach. Objective: To study the safety and feasibility of emergency appendicectomy for appendicular mass by comparing the complications, morbidity and mortality with conservatively treated patients. Materials & Methods: This is a prospective and comparative study conducted at Gitam Institute of Medical Sciences and Research, Visakhapatnam, from January 2018 to December 2019. A total of 60 patients with appendicular mass were divided into two groups of 30 each. Group I included patients who underwent emergency appendicectomy, while Group II consisted of patients who were managed conservatively. Results:In this study, patients' mean age was 27.58 yrs with a male to female ratio of 2.66:1. Intraoperative ndings in Group I - 20(70%) cases had simple mass, 8(26.66%) had adhesions and loculated pus in 2(6%). In Group II, 14(53.84%) patients had normal ndings, 4(15.38%) cases had simple mass, 6(23%) had adhesions, 1(3.84%) had loculated pus and adhesive intestinal obstruction. Postoperatively, In Group I, 3(10%) patients had wound infection, and 1(3.33%) patient developed fecal stula, which was managed conservatively. In Group II, 2(6.66) patients had wound infection, 4(13.33%) had failure of conservative treatment, four had lost follow-up, 3 had respiratory tract infection, and one patient developed intestinal obstruction due to adhesions. Mean length of hospital stay was 5.3 days in Group I and 8.5 days in Group II. Fewer complications, reduced number of days of parenteral medication, and reduced duration of total hospital stay were noted in Group I compared to Group II, indicating that emergency appendicectomy is a safe and feasible method of managing patients with appendicular mass.

Clinical Study of Right Iliac Fossa Mass Pathology At: Central Vidarbha Region

One of the most common problems experienced in surgical practice, which challenges the surgeon and needs the ability to diagnose through knowing the anatomy and pathological process that can occur inside the abdomen, is a mass in the right iliac fossa. The purpose of this research was to examine clinical appearance, differential diagnosis and treatment methods for patients with the right iliac fossa.Study was carried out in the Dept. of General Surgery at Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital, Sawangi (M), Wardha , Maharashtra , between August 2018 to December 2019. 43 patients with signs and symptoms of right iliac fossa mass were studied by taking detailed clinical history, physical examination, and were subjected to various investigations.In the present study appendicular mass constituted 60.46%, appendicular abscess 09.30% ,ileocaecal tuberculosis 06.97 % , carcinoma caecum 13.95 % , intussusseption02.32%. Patients presented with constitutional symptoms like pain , fever , vomiting , weight loss.Appendicular lump remains the most common entity in right iliac fossa mass patients. Ileocaecal tuberculosis is one of the most common differential diagnosis to be considered for pain abdomen evaluation in rural population. Conservative treatment followed by interval appendicectomy remains the main management modality in appendicular lump. The rare cause of mass in right iliac fossa as intussusception should be kept in mind.

Early Appendicectomy in Appendicular Mass- Review of Literature

The management of appendicular mass is a matter of controversy. Traditional management hasbeen conservative, with interval appendicectomy performed weeks after the mass had resolved.The need for interval appendicectomy (I.A) after successful conservative management of appendicularmass has recently been questioned. Furthermore, emergency appendicectomy for appendicularmass is increasingly performed with equal success and safety to that performed in nonmassforming acute appendicitis. The routine adoption of emergency appendicectomy in patientspresenting with appendicular mass obviates the need for a second admission and an operation forI.A. It also abolishes misdiagnoses and deals promptly with any unexpected ileo-cecal pathology.Early emergency appendicectomy is becoming the standard of care for appendicular mass. Journal of Surgical Sciences (2017) Vol. 21 (1) :33-35

Comparative study on surgical outcomes of needle port assisted two port laparoscopic appendicectomy verses conventional three-port laparoscopic appendicectomy

Background: Conventional three port laparoscopic appendicectomy is fast becoming a procedure of choice for appendicitis. Needle port assisted two port laparoscopic appendicectomy is the procedure with similar technique as conventional procedure but has its distinctive advantages. The present study aims to compare the results of needle port assisted two port and conventional three port laparoscopic appendicectomy.Methods: In comparative non-randomized study patients with acute appendicitis, recurrent appendicitis and patients posted for interval appendicectomy of age >18 years, both gender without co-morbidity were enrolled as subjects. Non-consenting patients were excluded. The study factor was needle port assisted two port and conventional three port laparoscopic appendicectomy procedure. The allocation to each procedure was done at random. The outcome factors were compared between both groups.Results: A total of 91 patients with a mean age of 29.77 years and F:M ratio of 1.67:1 were enrolled, of them 31 underwent needle port assisted two port laparoscopic appendicectomy. The mean operative time for two port was 53.38±7.97 min as compared to conventional three port was 44.65±5.86 min which was statistically significant but cosmetic outcome was better as well as statistically significant with two port procedure. The post-operative pain, intra-operative and post-operative complications were compared between these groups but were statistically not significant.Conclusions: Needle port assisted two port laparoscopic appendicectomy appears to give better cosmetic results and can be a good surgical alternative modality for uncomplicated appendicitis.

USG-Guided Percutaneous Aspiration: an Effective Way for Managing Appendicular Abscess

Background: During last 2−3 decades image-guided drainage procedures have been developed complementing modern surgical drainage techniques. The development of interventional radiological procedure has made percutaneous puncture and drainage of abdominal fluid collection possible. Image-guided percutaneous drainage of appendicular abscess has become well-established because of its proven safety and efficacy. Objectives: To evaluate the safety and feasibility of USG-guided percutaneous aspiration for draining appendicular abscess with special attention to the need for conversion and to see the nature of complications after draining of abscess. Materials and Methods: Between May 2013 to May 2014, 25 cases of appendicular abscess were selected from the admitted patients (surgery department) in Enam Medical College & Hospital who underwent USG-guided percutaneous aspiration. Procedure was performed mostly under local anaesthesia. Patients were followed up for 6 months. Interval appendicectomy was not performed routinely. Results: USG-guided aspiration was successful in 23 (92%) patients and in 2 (8%) patients procedure failed. Single attempt was successful in 21 (84%) cases and 4 (16%) patients needed double attempt for draining appendicular abscess. In 23 (92%) patients, PCA was done under local anaesthesia and two (8%) patients needed general anaesthesia. Complications developed in 4 (16%) patients. Four (16%) patients needed follow-up USG. Average hospital stay was 5 days (2−8 days) and average duration of using I/V antibiotic was 3.5 days (2−5 days). Conclusion: USG-guided percutaneous aspiration is an easy and safe method for draining appendicular abscess with minimum procedural complications. J Enam Med Col 2019; 9(1): 41-45

Laparoscopic Appendicectomy in All Benign Pathologies of the Appendix: A retrospective study

Background: Acute appendicitis is one of the most common surgical conditions and urgent appendicectomyis recommended and practiced for more than 100 years1,2. McBurney's appendicectomy by an open muscle splitting technique was the gold standard surgical procedure1. Laparoscopic appendicectomy (LA) is gaining popularity since 1987. But this new technique has a longer learning curve and requires expensive equipment (high capital investments).The aim of this study was to ascertain the generalizability of this novel procedure when appendicectomy is indicated.Method: This study was done over a period of six years in BIRDEM. Between March 2010 to February 2016, all consecutive cases of Laparoscopic appendicectomy was selected for the study. Operation was performed under general anaesthesia using standard three puncture technique. After the procedure all resected specimen was sent for histopathology.Result: Laparoscopicappendicectomy was attempted in 113 patients, 57(50.4%) female and 56(49.6%) males. Mean age of the patients were 35.2 years and ranged from 5 to 65 years. Laparoscopicappendicectomy was performed in emergency basis in 102(90%) due to acute appendicitis, gangrenous appendix, perforated appendix or appendicular abscess. Eleven patients (10%) underwent elective surgery due to interval appendicectomy, mucocole of appendix, incidental appendicectomy. The most common indication for laparoscopic appendicectomy in this series was acute appendicitis (62%). Only one patient (<1%) had to be converted to an open appendicectomy due to injury to caecal wall. There was no peri-operative mortality in this series. Hundred and five patients (93%) weredischarged in lessthan 24 hours of surgery and seven (6%) within 48 hours of surgery after removal of intrabdominal drain. Follow-up period was one month to two years.Conclusion: All the advantages of laparoscopy are well applied in laparoscopic appendicectomy. Morbidity, mortality and conversion rate came down to a minimum with time and experience. Hence laparoscopic appendicectomy should be the procedure of choice when appendicectomy in indicated.Bangladesh Crit Care J September 2018; 6(2): 80-83

A retrospective study on patients with appendicular mass after successful conservative treatment and to assess the need for interval appendicectomy

Background: Appendicular mass is one sequelae in unoperated cases of acute appendicitis which are managed conservatively followed by interval appendicectomy (IA). Currently the need for IA has been questioned due to low risk of recurrence.Methods: Data of all AM patients from 2005 to 2010 were collected and revised the following parameters: age, sex, length of hospital stay, symptoms and signs, total leucocyte count and USG. Those who developed similar pain and those who underwent emergency appendicectomy were considered as recurrence. Patients were grouped as: 1-patients who developed RIF pain,2-asymptomatic patients,3-patients who developed recurrent a/c appendicitis,4-patients who did not developed recurrent a/c appendicitis.Results: Of the 93 patients, 12 patients underwent IA. Average duration between mass resolution and recurrence is 4.16 months. 14.8% patients had recurrent similar abdominal pain, and only 7.4% patients had recurrent acute appendicitis. Length of hospital stay had a statistically significant correlation with recurrence. The mean TC in the group with recurrent acute appendicitis was 12,500 and asymptomatic group who had a mean TC of 10678.28 which was statistically significant.Conclusions: Conservative treatment is successful for majority of appendicular masses. A routine IA seems unnecessary. Asymptomatic patients can be followed up without IA. Most of the recurrences occur within the first 3 to 6 months. Length of hospital stay and total leucocyte count influenced the recurrence. IA may be considered in those who are prone for recurrence.