Evidence 1

Role of Routine Interval
Appendicectomy in case of
conservatively managed Acute
Appendicitis
EVIDENCE BASED DISCUSSION
ARTICLE RESULT CONCLUSION
1 Kaminski A, Liu IL, Applebaum H, Lee The type of appendicitis Most patients with acute
SL, Haigh PI. Routine interval -abscess in 7% of patients, appendicitis undergo
appendectomy is not justified after -peritonitis in 18%, appendectomy initially.
initial nonoperative treatment of acute -no peritonitis or abscess in 75%.
appendicitis. Arch Surg. 2005 Emergency appendectomy was performed For those treated
Sep;140(9):897-901. in 31926 (97%) patients. nonoperatively, the recurrence
doi:10.1001/archsurg.140.9.897. PMID: Nonoperative treatment -1012 patients rate is low.
16175691. (3%). Of Nonoperative, 148 (15%) had an Routine Interval
IA and the remaining 864 (85%) did not. Appendicectomy after initial
successful nonoperative
Thirty-nine patients (5%) recurred after a treatment is not justified and
median follow-up of 4 years. The type of should be abandoned.
appendicitis or percutaneous abscess
drainage had no influence on recurrence.
Median length of hospital stay was 4 days
for the admission for recurrent appendicitis
compared with 6 days for the IA admission
(P=.006).
2 Sakorafas GH, Sabanis D, Lappas C, The risk of recurrence is low but increases Interval appendectomy is not
Mastoraki A, Papanikolaou J, in the presence of the “risk factors”. routinely required in patients treated
Siristatidis C, Smyrniotis V. Interval Moreover, recurrences are usually conservatively for AA.
routine appendectomy following characterized by a milder clinical course Interval (or emergency) operation
conservative treatment of acute than the primary attack. Therefore routine should be considered in selected
appendicitis: Is it really needed. interval appendicectomy is probably not patients as in presence of "risk
World J Gastrointest Surg. 2012 Apr warranted following successful factors" indicating a high probability
27;4(4):83-6. doi: management of uncomplicated AA. of recurrence, such as retained fecal
10.4240/wjgs.v4.i4.83. PMID: stones, and following multiple(>2 or
22590661; PMCID: PMC3351492. 3) episodes of AA.
Patients with AA complicated by plastron or The lack of a sufficient body of

localized abscess formation should be evidence precludes firm
treated conservatively initially; recommendations.
image-guided percutaneous drainage may
be required to achieve drainage in patients
with localized abscess.
Despite that interval appendectomy is still
performed by the majority of surgeons
around the world, there is evidence that,
even in these cases, interval appendectomy
could be avoided
3 Tekin A, Kurtoğlu HC, Can I, Oztan S. Total patients 2862 acute appendicitis Routine interval appendicectomy after initial
Routine interval appendectomy is Non operative(mass)-98 successful conservative treatment is not justified
unnecessary after conservative -exclusion 4, and should be abandoned.
treatment of appendiceal mass. -conservatively treated 94
Colorectal Dis. 2008 Jun;10(5):465- Recommendation for the management of
8. doi: 10.1111/j.1463- Delayed surgery in 5 cases appendiceal mass:
1318.2007.01377.x. Epub 2007 Sep -1 obstruction(ca ceacum), (1) Initial conservative treatment, with surgical
13. PMID: 17868409. -1 difficult appendicectomy intervention if this fails;
Mersin City Hospital Jan1996- Jan -3 unresolved abcess, (2) no interval elective appendicectomy
2004 (3) identification of a caecal cancer by
Reccurrence rate 14.6% ( First 6 months subsequent investigation if indicated,
9 (10.1%), After 1 year 2 (2.2.%)) especially in patients over 40 years of age.
4 Lai HW, Loong CC, Wu CW, Lui WY. Of the 165 patients, 1 died after an acute Routine interval
Watchful waiting versus interval myocardial infarction. The rate of recurrence of appendectomy would
appendectomy for patients who appendicitis after conservative treatment was increase the cost per patient
recovered from acute appendicitis 25.5%(44/164). by 38% compared with follow-
with tumor formation: a cost- The median cost of up and appendectomy after
effectiveness analysis. J Chin Med -follow-up after conservative treatment recurrence.
Assoc. 2005 Sep;68(9):431-4. doi: NT$24,344.
10.1016/S1726-4901(09)70159-5. -interval appendectomy NT$47,746. Routine interval
PMID: 16187600. -Appendectomy after recurrent appendicitis appendectomy is not a cost-
NT$62,135. effective intervention.
Taipei Veterans General Hospital
between January 1998 and --Routine interval appendectomy (164/164)
December 2003 patients would have cost NT$7,830,344.
--The follow-up protocol with appendectomy after
recurrence(44/164) cost NT$5,655,220.
An additional NT$2,175,124 (38%) would have
been needed for routine interval appendectomy
compared with the follow-up policy, an extra
NT$13,263 per person.
ARTICLE CONCLUSION
5 Quartey B. Interval Appendiceal mass should be managed nonoperatively at the

appendectomy in adults: A initial presentation.
necessary evil? J Emerg Trauma Interval appendectomy is not indicated after successful
Shock. 2012 Jul;5(3):213- nonoperative management.
6.doi:10.4103/0974-2700.99683. The recurrence rate of acute appendicitis is low and
PMID: 22988397; PMCID: appendectomy can be safely performed at that time.
PMC3440885. The risk of missing the diagnosis of an underlying malignancy is
also low but we recommend additional evaluation with
colonoscopy or barium enema in patient over 40 years.
Nonoperative management has a cost advantage over routine
interval appendectomy after initial successful conservative
management.

Evidence 1

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Role of Routine Interval

Patients with AA complicated by plastron or The lack of a sufficient body of

5 Quartey B. Interval Appendiceal mass should be managed nonoperatively at the

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