The Eligibility of Conventional Interval Appendicectomy after Resolution by (Ochsner-Sherren) Regime in Appendicular Mass

Abstract

ABSTRACT

Background: The management of appendicular mass exhibit different modalities of treatments; which are optional and depend on many factors. Ochsner-Sherren regime followed by conventional or laparoscopic interval appendicectomy is one of options. 

Objectives: To compare conventional versus laparoscopic interval appendicectomy after mass resolution by (Ochsner-Sherren) regime.

Methods: A retrospective study that includes (106) patients with appendicular mass; divided into two groups with one group underwent conventional interval appendicectomy and other group by laparoscopic interval appendicectomy after response to Ochsner-Sherren regime.

Methods: A retrospective study that includes (106) patients with appendicular mass; divided into two groups with one group underwent conventional interval appendicectomy and other group by laparoscopic interval appendicectomy after response to Ochsner-Sherren regime. Results: One hundred and six patients with appendicular mass divided into two groups were included in the study. The first group included (51) patients; forty nine out of the (51) were subjected to the above regimen, (6) patients deteriorated clinically and  scheduled for surgery as they developed appendicular abscess, (2) out of the total came with appendicular abscess as their first presentation. In those (8) patients with early surgery, pelvic collection and intestinal obstruction were complications recorded and treated by trans-rectal drainage and adhesiolysis, respectively. There were no complications reported for the rest (43) cases that underwent conventional interval appendicectomy with lifetime duration of the conventional surgery ranging between (30-75) minutes with mean (52.5 minutes). The second group included (55) patients; while we continued on conservative regimen (7) out of those (55) patients were scoped for laparoscopy due to development of appendicular abscess, (5) out of this (7) patients had to be converted to conventional appendicectomy owing to failure of progression, as for the other (2) patients simple drainage procedure with tube drain insertion was considered at that time. Complications such as pelvic collection was treated with Transrectal drainage, (2) cases developed wound infections and was treated accordingly, (5) cases develop port sites infection were a sequelae for those (7) laparoscopic surgeries. Other complications included umbilical port omentocele  in (2) cases, cecal injury with primary repair was in (1) case and wound infections were recorded as a complication in the rest (48) cases who underwent laparoscopic interval appendicectomy with  lifetime duration of laparoscopic surgery ranging between (45-120) minutes with mean (82.5 minutes). Conclusions: The present  study  recommend  (Ochsner-Sherren) regimen followed by conventional interval appendicectomy which had been shown its safety, effectiveness, no mortality, less morbidity, less cost and can be apply in all centres. In spite of laparoscopic surgery is evolving procedure, less post-operative ileus time and early return to work; but it has long life time duration, technically demanding, same incidence of general complication, costy, high post-operative pain score, percent of conversion rate to conventional, not available in all centres and some time may lead to serious complication which may need other conventional surgery.