Komplikasyonsuz akut apandisit vakalarında birincil tıbbi tedavinin etkinliği ve güvenliği: tek merkezli retrospektif kohort çalışması

Öz

Amaç: Akut apandisit, akut karın ağrısının en yaygın nedenlerinden biridir ve geleneksel olarak apandektomi ile tedavi edilmiştir. Bununla birlikte, artan kanıtlar, antibiyotik tedavisinin, komplike olmayan akut apandisitli seçilmiş hastalarda güvenli bir alternatif olabileceğini göstermektedir. Bu çalışma, gerçek dünya klinik ve radyolojik verilerini kullanarak, komplike olmayan akut apandisitli hastalarda primer tıbbi tedavinin etkinliğini ve güvenliğini değerlendirmeyi amaçlamıştır. Gereç ve Yöntemler: Akut apandisit tanısı konmuş 289 hastayı içeren tek merkezli retrospektif kohort çalışması yapılmıştır. Hastalar, klinik ve bilgisayarlı tomografi bulgularına göre komplike olmayan apandisit olarak sınıflandırılmıştır. Yirmi üç hasta (%7,9) primer tıbbi tedavi alırken, 266 hasta (%92,1) primer cerrahi geçirmiştir. Demografik özellikler, apendiks çapı, apandikolit varlığı, tedavi sonuçları ve gecikmiş cerrahi ihtiyacı analiz edilmiştir. Sonuçlar: Tıbbi tedavi grubunda ortalama yaş 40,6 yıl, cerrahi tedavi grubunda ise 44,8 yıldı. Apendiks çapının medyan değeri, tıbbi tedavi gören hastalarda (8,0 mm [IQR: 7,5–8,25]) cerrahi tedavi görenlere (11,5 mm [IQR: 9,5–13,0], p < 0,001) göre anlamlı derecede daha küçüktü. Tıbbi tedavi grubunda apandikolit saptanmazken, cerrahi tedavi gören hastaların %12,8'inde apandikolit mevcuttu. Tıbbi tedavi gören 23 hastanın 19'unda (%82,6) cerrahi müdahale olmadan klinik iyileşme sağlandı. Dört hasta (%17,4) klinik durumun kötüleşmesi nedeniyle gecikmeli apandektomiye ihtiyaç duydu. Perforasyon, yaygın peritonit veya büyük ameliyat sonrası komplikasyon vakası gözlenmedi. Birincil tıbbi tedavi, komplike olmayan akut apandisitli, dikkatlice seçilmiş hastalarda cerrahiye güvenli ve etkili bir alternatiftir. Uygun hasta seçimi, özellikle apandisit taşı dışlanması ve yakın klinik takip, komplikasyon oranlarını artırmadan hastaların önemli bir bölümünün cerrahi müdahaleden kaçınmasını sağlar.

Anahtar Kelimeler

• Akut Apandisit
• Antibiyotik Tedavisi
• Konservatif Tedavi
• Apandektomi
• Bilgisayarlı Tomografi

Effectiveness and safety of primary medical treatment in uncomplicated acute appendicitis: a single-center retrospective cohort study

Öz

Aim: Acute appendicitis is one of the most common causes of acute abdominal pain and has traditionally been treated with appendectomy. However, increasing evidence suggests that antibiotic therapy may be a safe alternative in selected patients with uncomplicated acute appendicitis. This study aimed to evaluate the effectiveness and safety of primary medical treatment in patients with uncomplicated acute appendicitis using real-world clinical and radiological data. Materials and Methods: A single-center retrospective cohort study was conducted including 289 patients diagnosed with acute appendicitis. Patients were classified as having uncomplicated appendicitis based on clinical and computed tomography findings. Twenty-three patients (7.9%) received primary medical treatment, while 266 patients (92.1%) underwent primary surgery. Demographic characteristics, appendix diameter, presence of appendicolith, treatment outcomes, and need for delayed surgery were analyzed. Results: The mean age was 40.6 years in the medical treatment group and 44.8 years in the surgical group. The median appendix diameter was significantly smaller in patients treated medically (8.0 mm [IQR: 7.5–8.25]) compared to those treated surgically (11.5 mm [IQR: 9.5–13.0], p < 0.001). No appendicolith was detected in the medical treatment group, whereas it was present in 12.8% of surgically treated patients. Clinical recovery without surgery was achieved in 19 of 23 patients (82.6%) receiving medical treatment. Four patients (17.4%) required delayed appendectomy due to clinical deterioration. No cases of perforation, generalized peritonitis, or major postoperative complications were observed. Conclusion; Primary medical treatment is a safe and effective alternative to surgery in carefully selected patients with uncomplicated acute appendicitis. Appropriate patient selection, particularly exclusion of appendicolith and close clinical follow-up, allows a substantial proportion of patients to avoid surgical intervention without increasing complication rates.

Anahtar Kelimeler

• Acute Appendicitis
• Antibiotic Therapy
• Conservative Treatment
• Appendectomy
• Computed Tomography

Kaynakça

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