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Emergency versus interval appendectomy in patients with plastron appendicitis: a comparative analysis of clinical outcomes

Year 2025, Volume: 50 Issue: 3, 849 - 855, 30.09.2025
https://doi.org/10.17826/cumj.1711894

Abstract

Purpose: This study aims to investigate the clinical results of emergency and interval appendectomy in adult patients diagnosed with plastron.
Materials and Methods: Patients with plastron appendicitis who underwent either emergency appendectomy (within 24 hours of admission) or interval appendectomy (4-16 weeks after initial conservative treatment) were included in this study. The primary outcome was length of hospital stay, with secondary outcomes including ICU admission, postoperative complications, and appendectomy completion rate in emergency appendectomy.
Results: Among the 77 patients, 55 were planned to have an emergency appendectomy performed; however, only 36 of these patients actually underwent emergency appendectomy, and 19 (34.5%) were unable to have an appendectomy and were instead scheduled for interval appendectomy. Including these patients, a total of 41 patients underwent interval appendectomy. Total hospital stay was significantly longer in the interval group (6.3 ± 5.7 vs. 9.1 ± 5.1). In the interval group, the mean time from initial presentation to surgery was 70.0±27.5 days (25-134 days). Laparoscopy was more frequent in the interval group (8.3% vs. 73.2%), and the complication rate was higher in emergency appendectomies.
Conclusion: Emergency appendectomy was associated with higher rates of incomplete appendectomy. Although the hospital stay is longer in interval appendectomies, interval appendectomy may be preferred in patients with suspected plastron appendicitis to avoid a second operation.

Ethical Statement

The study protocol was approved by the Ethics Committee of Mersin University

References

  • Borruel Nacenta S, Ibáñez Sanz L, Sanz Lucas R, Depetris MA, Martínez Chamorro E, García Espinosa J. Update on acute appendicitis: typical and untypical findings. Radiologia (Engl Ed). 2023;65:81-91.
  • Karakaş DÖ, Yeşiltaş M, Gökçek B, Eğin S, Hot S. Periappendicular inflammatory masses. Turk J Colorectal Dis. 2020;30:191-97.
  • Zhou S, Cheng Y, Cheng N, Gong J, Tu B. Early versus delayed appendicectomy for appendiceal phlegmon or abscess. Cochrane Database Syst Rev. 2024;5:CD011670.
  • Kumar HR, Soma M, Ganesh R. Current management of appendicular mas - a narrative review. Med J Malaysia. 2023;78:669-74.
  • Tannoury J, Abboud B. Treatment options of inflammatory appendiceal masses in adults. World J Gastroenterol. 2013;19:3942-950.
  • Kanaka S, Mizutani S, Yokoyama Y, Matsutani T, Chihara N, Katsuno A et al. Periappendiceal fluid collection on preoperative computed tomography can be an indication for interval appendectomy: a retrospective study. World J Emerg Surg. 2022;17:30.
  • MDCalc [Internet]. Charlson Comorbidity Index (CCI). https://www.mdcalc.com/calc/3917/charlson-comorbidity-index-cci. (Accessed 1.1.2025)
  • Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson comorbidity index: a critical review of clinimetric properties. Psychother Psychosom. 2022;91:8-35.
  • Bolliger M, Kroehnert JA, Molineus F, Kandioler D, Schindl M, Riss P. Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients. Eur Surg. 2018;50:256-61.
  • Ozdemir K, Harmantepe AT, Dulger UC, Gonullu E, Dikicier E, Bayhan Z et al. Comparison of treatment methods in plastron appendicitis: a tertiary center experience. Malawi Med J. 2023;35:224-27.
  • Kimura T, Toyoki Y, Ichisawa A, Miyata H, Inoue Y, Kitta T et al. Aiming for minimally invasive treatment of pediatric acute appendicitis in a district hospital. Ann Pediatr Surg. 2021;17:18.
  • Azılı C, Tokgöz S, Chousein B, Tamam S, Benk MŞ, Culcu S et al. Determination of risk factors for conversion from laparoscopic to open appendectomy in patients with acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2023;29:1103-8.
  • Pushpanathan NR, Hashim MNM, Zahari Z, Aziz SHSA, Zain WZW, Ramely R et al. Conversion rate and risk factors of conversion to open in laparoscopic appendicectomy. Ann Coloproctol. 2022;38:409-14.
  • Mejri A, Arfaoui K, Mseddi MA, Slima MB, Saad S, Yahyaoui M. The management of appendicular abscesses in a Tunisian tertiary care hospital. BMC Surg. 2021;21:427.
  • Suzuki T, Matsumoto A, Akao T, Matsumoto H. Interval appendectomy as a safe and feasible treatment approach after conservative treatment for appendicitis with abscess: a retrospective, single-center cohort study. Updates Surg. 2023;75:2257-65.

Plastron apandisiti olan hastalarda acil ve aralıklı apendektomi: klinik sonuçların karşılaştırmalı analizi

Year 2025, Volume: 50 Issue: 3, 849 - 855, 30.09.2025
https://doi.org/10.17826/cumj.1711894

Abstract

Amaç: Bu çalışma, plastron tanısı konulan yetişkin hastalarda acil ve aralıklı apendektominin klinik sonuçlarını araştırmayı amaçlamaktadır.
Gereç ve Yöntem: Acil apendektomi (kabulden itibaren 24 saat içinde) veya interval apendektomi (konservatif tedaviden 4-16 hafta sonra) geçiren plastron apandisitli hastalar çalışmaya dahil edildi. Birincil sonuç hastanede kalış süresiydi, ikincil sonuçlar arasında yoğun bakım ünitesine yatış, ameliyat sonrası komplikasyonlar ve acil apendektomide apendektomi tamamlanma oranı yer aldı.
Bulgular: 77 hastadan 55'ine acil apendektomi yapılması planlandı; ancak bu hastalardan sadece 36'sına acil apendektomi yapıldı. 19'una (%34,5) apendektomi yapılamadı ve interval apendektomi planlandı. Bu hastalar dahil olmak üzere toplam 41 hastaya interval apendektomi yapıldı. Toplam hastanede kalış süresi interval apendektomilerde önemli ölçüde daha uzundu (6,3 ± 5,7'ye karşı 9,1 ± 5,1). İnterval apendektomilerde, ilk başvurudan ameliyata kadar geçen ortalama süre 70,0 ± 27,5 gündü (25-134 gün). Laparoskopik operasyon interval appendektomilerde daha sıktı (%8,3'e karşı %73,2) ve acil apendektomilerde komplikasyon oranı daha yüksekti.
Sonuç: Acil apendektomi daha yüksek oranda tamamlanmamış apendektomi ile ilişkilendirilmiştir. Hastanede kalış süresi interval apendektomilerde daha uzun olsa da, plastrone apandisit şüphesi olan hastalarda ikinci bir operasyondan kaçınmak için interval apendektomi tercih edilebilir.

Ethical Statement

Mersin Üniversitesi Etik Kurulu tarafından onaylanmıştır

References

  • Borruel Nacenta S, Ibáñez Sanz L, Sanz Lucas R, Depetris MA, Martínez Chamorro E, García Espinosa J. Update on acute appendicitis: typical and untypical findings. Radiologia (Engl Ed). 2023;65:81-91.
  • Karakaş DÖ, Yeşiltaş M, Gökçek B, Eğin S, Hot S. Periappendicular inflammatory masses. Turk J Colorectal Dis. 2020;30:191-97.
  • Zhou S, Cheng Y, Cheng N, Gong J, Tu B. Early versus delayed appendicectomy for appendiceal phlegmon or abscess. Cochrane Database Syst Rev. 2024;5:CD011670.
  • Kumar HR, Soma M, Ganesh R. Current management of appendicular mas - a narrative review. Med J Malaysia. 2023;78:669-74.
  • Tannoury J, Abboud B. Treatment options of inflammatory appendiceal masses in adults. World J Gastroenterol. 2013;19:3942-950.
  • Kanaka S, Mizutani S, Yokoyama Y, Matsutani T, Chihara N, Katsuno A et al. Periappendiceal fluid collection on preoperative computed tomography can be an indication for interval appendectomy: a retrospective study. World J Emerg Surg. 2022;17:30.
  • MDCalc [Internet]. Charlson Comorbidity Index (CCI). https://www.mdcalc.com/calc/3917/charlson-comorbidity-index-cci. (Accessed 1.1.2025)
  • Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson comorbidity index: a critical review of clinimetric properties. Psychother Psychosom. 2022;91:8-35.
  • Bolliger M, Kroehnert JA, Molineus F, Kandioler D, Schindl M, Riss P. Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients. Eur Surg. 2018;50:256-61.
  • Ozdemir K, Harmantepe AT, Dulger UC, Gonullu E, Dikicier E, Bayhan Z et al. Comparison of treatment methods in plastron appendicitis: a tertiary center experience. Malawi Med J. 2023;35:224-27.
  • Kimura T, Toyoki Y, Ichisawa A, Miyata H, Inoue Y, Kitta T et al. Aiming for minimally invasive treatment of pediatric acute appendicitis in a district hospital. Ann Pediatr Surg. 2021;17:18.
  • Azılı C, Tokgöz S, Chousein B, Tamam S, Benk MŞ, Culcu S et al. Determination of risk factors for conversion from laparoscopic to open appendectomy in patients with acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2023;29:1103-8.
  • Pushpanathan NR, Hashim MNM, Zahari Z, Aziz SHSA, Zain WZW, Ramely R et al. Conversion rate and risk factors of conversion to open in laparoscopic appendicectomy. Ann Coloproctol. 2022;38:409-14.
  • Mejri A, Arfaoui K, Mseddi MA, Slima MB, Saad S, Yahyaoui M. The management of appendicular abscesses in a Tunisian tertiary care hospital. BMC Surg. 2021;21:427.
  • Suzuki T, Matsumoto A, Akao T, Matsumoto H. Interval appendectomy as a safe and feasible treatment approach after conservative treatment for appendicitis with abscess: a retrospective, single-center cohort study. Updates Surg. 2023;75:2257-65.
There are 15 citations in total.

Details

Primary Language English
Subjects General Surgery
Journal Section Research
Authors

Cumhur Özcan 0000-0002-6453-025X

Simge Tuna 0009-0007-2578-9107

Zafer Can Kesikminare 0009-0009-9392-2920

Mustafa Yılmaz 0000-0001-5455-3258

Tahsin Çolak 0000-0002-7253-5608

Publication Date September 30, 2025
Submission Date June 2, 2025
Acceptance Date August 23, 2025
Published in Issue Year 2025 Volume: 50 Issue: 3

Cite

MLA Özcan, Cumhur et al. “Emergency versus Interval Appendectomy in Patients With Plastron Appendicitis: A Comparative Analysis of Clinical Outcomes”. Cukurova Medical Journal, vol. 50, no. 3, 2025, pp. 849-55, doi:10.17826/cumj.1711894.