Objective:

In this prospective study nonoperative management of acute appendicitis is evaluated regarding safety and cost effectivity.

Material and Methods:

Between March 2005-March 2006, 107 patients hospitalized for medical treatment among a total number of 380 patients with acute appendicitis were included in this study. Informed consents of the patients were obtained. Intravenous fluid + antibiotherapy with ampicillin 1 g 4x1 daily + gentamicin 160 mg/day + metronidazole 500 mg 3x1 daily and analgesic with diclophenac sodium 50-75 mg 3x1 im daily were administered to the patients after cessation of oral feeding. Patients resistant to medical therapy confirmed by radiologic and physical examination were operated. Patients with clinical improvement were discharged on the 3rd day of treatment with oral antibiotherapy completed to 10 days. Routine follow up controls were done on the 10rd day, 3th month and 6th months after dischargewith hemograms and ultrasonography.

Results:

Male to female ratio was 65/42 with a mean age of 38 (16-65). 19 (17.8%) of these patients were operated. Mean follow up period was 136 days (21-360). Operation indication was resistance to therapy in 11, patients’ choice in 5, operation inanother hospital in 3 patients. During the follow up period recurrence occurred in 9 patients and 7 of them were treated surgically whereas 2 were retreated medically. Mean hospital stay in the nonoperative therapy group was 3 days (2-5). Mean cost of the therapy was 585 YTL in the nonoperative group and 755 YTL in the operated ones.

Conclusion:

With high success rate and cost effectivity, medical treatment seems to be a good alternative to the gold standard therapy of surgery in the management of acute appendicitis.

Keywords: Acute appendicitis, antibiotherapy, non-operative management, surgery