A Systematic Review of Perforated Appendicitis and Phlegmon: Interval Appendectomy or Wait-and-See?

Ghaleb Darwazeh, Steven C. Cunningham, Gopal C. Kowdley

Research output: Contribution to journalArticle

Abstract

Patients with appendiceal abscess or phlegmon have been traditionally managed with antibiotics and radiologically guided drainage of the abscess. Many studies have questioned the need for interval appendectomy. A systematic review of the nonsurgical treatment of patients with an appendiceal abscess or phlegmon was undertaken. The rate of recurrence after nonsurgical management, morbidity and length of hospital stay was measured. PubMed and Cochrane databases were queried to identify 21 studies reporting the morbidity of nonsurgical treatment of appendiceal phlegmon or abscess, and five studies reporting the morbidity of performing interval appendectomy. Repeat nonsurgical management was compared with that of performing interval appendectomy. The studies included a total of 1943 patients, of which 1400 patients were managed nonsurgically and 543 patients underwent interval appendectomy. Nonoperative treatment had a mean recurrence of 12.4 per cent, a morbidity of 13.3 per cent, and the length of hospital stay was 9.6 days. The mean morbidity rate and length of hospital stay for patients who underwent interval appendectomy was 10.4 per cent and 5.0 days, respectively. Interval appendectomy and repeat nonoperative management in case of recurrence are associated with similar morbidity; however, elective interval appendectomy implies additional operative costs to prevent recurrence in one of eight patients.

LanguageEnglish (US)
Pages11-15
Number of pages5
JournalAmerican Surgeon
Volume82
Issue number1
StatePublished - Jan 1 2016

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Appendectomy
Cellulitis
Appendicitis
Length of Stay
Morbidity
Abscess
Recurrence
Case Management
PubMed
Drainage
Therapeutics
Databases
Anti-Bacterial Agents
Costs and Cost Analysis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

A Systematic Review of Perforated Appendicitis and Phlegmon : Interval Appendectomy or Wait-and-See? / Darwazeh, Ghaleb; Cunningham, Steven C.; Kowdley, Gopal C.

In: American Surgeon, Vol. 82, No. 1, 01.01.2016, p. 11-15.

Research output: Contribution to journalArticle

Darwazeh, G, Cunningham, SC & Kowdley, GC 2016, 'A Systematic Review of Perforated Appendicitis and Phlegmon: Interval Appendectomy or Wait-and-See?' American Surgeon, vol. 82, no. 1, pp. 11-15.
Darwazeh, Ghaleb ; Cunningham, Steven C. ; Kowdley, Gopal C./ A Systematic Review of Perforated Appendicitis and Phlegmon : Interval Appendectomy or Wait-and-See?. In: American Surgeon. 2016 ; Vol. 82, No. 1. pp. 11-15
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