More recently questions have been raised as to whether interval appendectomy should be performed or not with many researchers believing that watchful waiting is more cost effective option as the incidence of recurrent episodes of appendicitis are quite less. What is your opinion?
Thank you for your reply. If at recurrence patient again presents with a lump, then what do you suggest
Thank you for clarifying but I want to know whether you perform interval appendectomy after the second episode of conservative management of appendicular lump
There is no need to do interval appendectomy unless patient is symptomatic. I did not have any major issues with this guide line.
Interval Appendectomy is not necessary if symptoms resolve with antibiotics and no residual disease. However, If you are not going to do an interval appendectomy you must perform a colonoscopy to rule out cancer in the cecum.
If the patient is completely free of symptoms after conservative therapy with interventional drainage of abscess within the periappendicular mass, interval appendectomy is not necessary. But if there remains some symptoms, it is wise to remove the appendix - but this can be a 'real demanding' operation'
Agree absolutely with Dr. Eriksson. Most large studies show interval appendicectomy is not necessary, but absolutely, patients ought to have their caecum imaged either via optical colonoscopy or barium enema. Barium is helpful as it can show if the appendix lumen is patent (and hence recurrence or appendicular colic is likely), but obviously can miss small caecal lesions.
FYI: Kaminski A, Liu IL, Applebaum H, Lee SL, Haigh PI. Routine interval appendectomy is not justified after initial nonoperative treatment of acute appendicitis. Arch Surg. 2005 Sep;140(9):897-901.
Once its appendicitis/appendicular mass, if the patient is not operated, there is around 40% chance of recurrence and can increase the morbidity, even mortality.
I perform routine interval appendectomy after the mass resolves.colonoscopy is adviceble to exclude any pathology in the caecum.
Not mentioned here thusfar is the option to perform either CT pneumocolon or interval CT scan. These alternatives are available when the patient has factors preventing colonoscopy from being undertaken.
Current evidence suggest no indication for routine interval appendectomy, as > 80% of patients have no recurrent attacks. On selected cases I may request for ultrasound to determine if appendix lumen is patent, which may give rise to further episodes.
I perform CT particularly in patients older 40 years, and selectively colonoscopy
Thank you Prof Barkeji for your views....what is the selection procedure for colonoscopy
Hi,
I'm curious in this discussion because I was diagnosed with appendicular lump last year June.
I was treated with OS regimen and I did no go through a surgery after. Should I need a follow up check up or it is just over?
I was treated with OS regimen last year June and I did no go through a surgery after. Should I need a follow up check up or it is just over?
even though current current shows that you donot need to rush and get operated,but in a younger age group like yours ,my suggestion is to get operated .
i think there is no need to do appendectomy after appendicular mass resolution unless the patient is diabetic or immune suppressed.
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