Retraction Note to: Conservative Management of Acute Appendicitis Prospective evaluation of nonsurgical versus surgical management of appendiceal mass. Conservative approach versus urgent appendectomy in surgical management of acute appendicitis with abscess or phlegmon. A National Evaluation of the Conservative Management of Uncomplicated Acute Appendicitis: How Common Is This and What Are the Issues? Evaluation of early surgical management of complicated appendicitis by appendicular mass. Comparison of operative and non operative management of acute appendicitis. Laparoscopic versus open appendicectomy for complicated appendicitis: A prospective study Appendiceal mass: conservative therapy followed by interval laparoscopic appendectomy. Initial laparoscopic appendectomy versus initial nonoperative management and interval appendectomy for perforated appendicitis with abscess: a prospective, randomized trial. [Laparoscopic or classical appendectomy? A prospective randomized study]. Treatment of appendiceal mass: prospective, randomized clinical trial. Diagnostic laparoscopy reduces unnecessary appendicectomy in fertile women. Laparoscopic versus open appendectomy: prospective randomized trial. RETRACTED ARTICLE: Conservative Management of Acute Appendicitis Laparoscopic versus open appendectomy in children: a prospective randomised study. Laparoscopy in children with complicated appendicitis. Laparoscopic versus Open Appendectomy: Prospective Randomized Trial
The editors of the Journal of Gastrointestinal Surgery as well as the SSAT Board of Directors have retracted the article Malik , A.A. & Bari , S.U. Conservative management of  acute appendicitis . J Gastrointest . Surg 13 , 966–970 ( 2009 ) since significant portions of the article were published earlier in the following articles : Eriksson , S. & Granstrom , L. R and omized controlled trial of appendectomy versus antibiotic therapy for acute appendicitis . Br J Surg 82 , 166–169 ( 1995 ) . Horton , M.D. , Counter , S.F. , Florence , M.G. & Hart , M.J. A prospect i ve trial of computed tomography and ultrasonography for diagnosing  appendicitis in the atypical patient . Am J Surg 179 , 379–381 ( 2000 ) PURPOSE Prospect i ve evaluation was undertaken of surgical findings , complications , morbidity , and hospital stay between initial nonsurgical management versus early surgical intervention of an appendicular mass . METHODS A prospect i ve , nonr and omized study was conducted of 82 consecutive patients ( mean age , 6.9 + /- 3.3 years ) presenting with an appendicular mass over a 5-year period . They were categorized as group 1 , 58.5 % ( 48 of 82 ) nonsurgically managed and an interval appendectomy performed at a mean period of 8.6 + /- 4.6 weeks and group 2 , 41.5 % ( 34 of 82 ) appendectomy at presentation . RESULTS An appendix was identified in all 82 patients in both groups at operation . In-group 1 , recurrent episodes of abdominal pain necessitated interval appendectomy in 39.6 % ( 19 of 48 ) patients at a mean 4.3 + /- 0.8 versus 11.5 + /- 3.7 weeks in 60.4 % ( 29 of 48 ) who underwent scheduled interval appendectomy .  Periappendiceal abscesses present at interval appendectomy in group 1 was ( 38 of 48 ) 79.2 % versus 100 % ( 34 of 34 ) at appendectomy in group 2 . Adhesions at interval appendectomy  in group 1 was 81.3 % ( 39 of 48 ) versus 100 % ( 34 of 34 ) at appendectomy in group 2 . In-group 1 , superficial wound infection was observed in 0 versus 4 wound infections in group 2 . Overall morbidity rate between group 1 and group 2 was statistically significant ( P < .05 ) . Total mean hospital stay in group 1 was 13.2 + /- 1.5 versus 4.8 + /- 0.4 days in group 2 . Of the 48-interval appendectomy specimens , 37 of 48 ( 77 % ) appendices had a patent lumen , and 11 of 48 ( 23 % ) showed fibrosis and obliteration of appendicular lumen . There was no correlation ( r = 0.22 ) between the histopathologic findings and the interval between abscess treatment and interval appendectomy . CONCLUSIONS Early surgical intervention was beneficial over nonoperative management in this cohort of patients . Interval appendectomy is recommended after nonsurgical management of an appendicular mass BACKGROUND Surgical management of acute appendicitis with appendiceal abscess or phlegmon remains controversial . We studied the results of initial conservative treatment ( antibiotics and percutaneous drainage if necessary , with or without interval appendectomy ) compared with immediate surgery . METHODS We undertook an observational , retrospective cohort study of patients with a clinical and radiological diagnosis of acute appendicitis with an abscess or phlegmon , treated in our hospital between January 1997 and March 2009 . Patients younger than 14 , with severe sepsis or with diffuse peritonitis were excluded . A study group of 15 patients with acute appendicitis complicated with an abscess or phlegmon underwent conservative treatment . A control group was composed of the other patients , who all underwent  urgent appendectomy  , matched for age and later r and omized 1:1 . The infectious risk stratification was established with the National Nosocomial Infections Surveillance System ( NNIS ) index . Dependent variables were hospital stay and surgical site infection . Analysis was with SPSS , with p < 0.05 considered significant . RESULTS Interval appendectomy  was performed in 7 study group patients . Surgical site infection episodes were more frequent in the control group ( 6 vs. 0 , p < 0.001 ) . A greater percentage of high risk patients ( NNIS ≥ 2 ) was identified in the control group ( 80 vs. 28.7 % , p < 0.03 ) , mostly related with contaminated or dirty procedures in this group ( p < 0.001 ) . No significant difference between groups was found in hospital stay . CONCLUSION Initial conservative treatment should be considered the best therapeutic choice for acute appendicitis with abscess or phlegmon Introduction : The management approach for acute appendicitis has been challenged in recent years , with numerous r and omized controlled trials demonstrating that antibiotics/conservative management is an efficacious treatment , with lower complication rates . Methods : A national survey of all consultant general surgeons evaluating their practice s was performed . Reasons for changed practice s , choice of antibiotics and follow-up investigations were evaluated . In addition , the role of interval appendicectomy and conservative management in the pediatric population was also assessed . Results : The response rate for this survey was 74.7 % ( n = 74/99 ) . Over one-fifth ( n = 17 , 22.9 % ) routinely treat acute appendicitis conservatively , while another 14.8 % ( n = 11 ) consider this approach in selected cases . Main reasons for modified practice s included the presence of inflammatory phlegmon ( 75 % ) , delayed presentation ( 64 % ) , and recent evidence -based medicine developments ( 46 % ) . Co-amoxiclav/clavulanic acid was the most popular antibiotic for conservative management ( 53 % ) . Alternatively , combinations of antibiotics were also utilized . One-third felt interval appendicectomy was warranted , while one-fifth supported conservative management in the paediatric setting . The overwhelming majority ( > 95 % ) advocate follow-up colonoscopy ± computed tomography in any patient aged > 40 years managed conservatively . Conclusion : Considerable variation in management of uncomplicated appendicitis  remains in Irel and despite growing evidence suggesting that the non-operative approach is safe . Reasons for adopting a conservative management practice have been identified and reflect the exp and ing literature on this subject AIM This prospect i ve study was done to evaluate the feasibility and safety of immediate appendicectomy in the presence of appendicular mass . METHODS A prospect i ve , nonr and omized study was conducted over 46 consecutive patients ( mean age : 24 ± 8.76 years ) presenting with an appendicular mass over a 4-year period . They were subjected for immediate appendicectomy within 24 h of admission . RESULTS The appendix was identified and removed in all 46 patients at operation . Peri-appendiceal abscesses were present in 25 % ( 11 of 46 ) . There was difficulty with adhesolysis and localization of the appendix in 10%(4 ) of patients . Superficial wound infection had occurred in 8(17 % ) while deep wound infection had occurred in 9%(4 ) patients . The mean hospital stay was 3 ± 0.25 day . No major complications had occurred . CONCLUSIONS Early surgical intervention in patients with an appendicular mass  is feasible , safe and avoids the consequences of the misdiagnosis and mistreatment of other surgical pathologies BACKGROUND In this prospect i ve study , operative and nonoperative management of acute appendicitis were evaluated regarding their safety and cost effectiveness . METHODS Two hundred ninety patients presenting to our Emergency Department between March 2005 and March 2006 with acute appendicitis were included in this prospect i ve study . Nonoperative medical therapy was performed in 107 patients ( Group 1 ) , and 183 patients were treated surgically ( Group 2 ) . Routine follow-up controls were done on the 10th day , at the 3rd and 6th months and at the first year after discharge in Group 1 . Both groups were compared regarding age , gender , mean hospital stay , modified Alvarado score , morbidity , mortality , and cost effectiveness . RESULTS The male/female ratio of Groups 1 and 2 were 65/42 ( mean age : 30.98+/-1.30 ) and 125/58 ( mean age : 26.25+/-0.79 ) , respectively . In Group 1 , 19 patients were operated . Operation indications were resistance to therapy , patient 's request , and operation in another hospital . Although the mean hospital stay of Group 1 was statistically significantly longer than Group 2 , the mean cost of the therapy was $ 559 in Group 2 and $ 433 in Group 1 . Morbidity rates were similar , with no mortality in either group . CONCLUSION With its high success rate and cost effectiveness , medical treatment seems to be a good alternative to the gold st and ard therapy of surgery in management of acute appendicitis Aims : The purpose of this study was to compare open versus laparoscopic appendicectomy ( LA ) in complicated appendicitis . Material s and Methods : We prospect ively analyzed all children over a 2-year period who underwent appendicectomy in a single institution and found 30 cases of complicated appendicitis diagnosed on the table and confirmed by histopathology . These children were allocated r and omly into Group 1 if they had LA and Group 2 if they had open appendicectomy ( OA ) , solely based on surgeon assessment . The parameters assessed were duration of symptoms before surgery , use of postoperative parenteral analgesia , timing of initiation of feeds after surgery , postoperative complications and duration of postoperative stay . Results : Of the 30 patients with complicated appendicitis , 12 patients in Group 1 underwent LA and 18 patients in Group 2 underwent OA . The two groups were comparable for age and sex . Children in Group 1 were found to need less parenteral analgesia ( two out of 12 versus six out of 18 ) . Postoperatively , feeds were started earlier in Group 1 than in Group 2 ( 2.5 days versus 3.7 days ) . The average postoperative hospital stay was 5 days in Group 1 and 7.5 days in Group 2 . There were only minor wound infections in Group1 as against two major complications in Group 2 . There was no mortality in either group . Conclusions : In complicated appendicitis , laparoscopic approach carries definite advantages with less postoperative morbidity and hospital stay . It is a feasible and better alternative than the open approach in complicated appendicitis BACKGROUND Current therapy of patients with appendiceal abscess or phlegmon is in evolution . Controversial areas include initial conservative therapy , drainage of periappendiceal abscesses , and the role of interval appendectomy . OBJECTIVE To evaluate the safety and efficacy of conservative therapy and of interval laparoscopic appendectomy ( ILA ) . PATIENTS AND METHODS Patients with signs and symptoms of acute appendicitis and a palpable right lower quadrant mass were included . Abscess/phlegmon was documented with ultrasound or computerized tomography . After initial therapy with antibiotics , patients were discharged to home . ILA was performed 6 to 12 weeks later . RESULTS Twelve patients were included . Four patients had phlegmonous appendicitis and eight had an abscess , but only four had percutaneous drainage . All patients improved without surgical exploration and were subjected to ILA . ILA was successful in 11 of 12 patients ; a median hospital postoperative stay of 1 day was required , and no perioperative morbidity was encountered . All patients returned to routine activities within 2 weeks of surgery . CONCLUSIONS 1 ) Initial conservative management of patients with appendiceal abscess/phlegmon is prudent , safe , and effective . 2 ) Interval laparoscopic appendectomy can be performed safely and effectively INTRODUCTION Perforated appendicitis is a common condition in children , which , in a small number of patients , may be complicated by a well-formed abscess . Initial nonoperative management with percutaneous drainage/aspiration of the abscess followed by intravenous antibiotics usually allows for an uneventful interval appendectomy . Although this strategy has become well accepted , there are no published data comparing initial nonoperative management ( drainage/interval appendectomy ) to appendectomy upon presentation with an abscess . Therefore , we conducted a r and omized trial comparing these 2 management strategies . METHODS After internal review board approval ( # 06 11 - 164 ) , children who presented with a well-defined abdominal abscess by computed tomographic imaging were r and omized on admission to laparoscopic appendectomy or intravenous antibiotics with percutaneous drainage of the abscess  ( when possible ) , followed by interval laparoscopic appendectomy approximately 10 weeks later . This was a pilot study with a sample size of 40 , which was based on our recent volume of patients presenting with appendicitis and abscess . RESULTS On presentation , there were no differences between the 2 groups regarding age , weight , body mass index , sex distribution , temperature , leukocyte count , number of abscesses , or greatest 2-dimensional area of abscess in the axial view . Regarding outcomes , there were no differences in length of total hospitalization , recurrent abscess rates , or overall charges . There was a trend toward a longer operating time in patients undergoing initial appendectomy ( 61 minutes versus 42 minutes mean , P = .06 ) . CONCLUSIONS Although initial laparoscopic appendectomy trends toward a requiring longer operative time , there seems to be no advantages between these strategies in terms of total hospitalization , recurrent abscess rate , or total charges Though laparoscopic appendectomy started endoscopic surgery in general surgery , it has yet not reached the acceptance as is the case with cholecystectomy . The application of this technique in possibly bl and appendices and reports that the technique was accompanied by severe complications , increases the scepticism about it . This made us decide to start a r and omized controlled trial : laparoscopic vs. conventional appendectomy . More than 1000 endoscopic interventions mainly performed at the gallbladder and the stomach and 165 prospect ively documented and partly treated patients with acute appendicitis were the basis to start this trial . " Acute Appendicitis " was diagnosed on the basis of clinical symptoms by means of the computer-aided question naire of the EC- study " Acute Abdominal Pain " , a self-developed vali date d diagnostic score , the macroscopic findings and the careful assessment of the histology of the resected appendix . Beside the technical feasibility , principle end-points were mainly intensity and course of postoperative pain measured by means of the Visual Analogue Scale ( VAS ) in lying , st and ing and moving position and the postoperative consumption of analgesics . We assessed a difference of 15 points on the VAS as clinical ly relevant . Of 57 patients with acute appendicitis we performed open appendectomy in 23 and laparoscopy in 34 patients according to r and omization . In 9 patients of the laparoscopy group it was necessary to change over to open appendectomy for different reasons result ing in a direct comparison of 25 laparoscopies versus 23 open appendectomies . There were no differences between sociodemographic and pre clinical data in both groups . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND Appendiceal mass may be treated in several ways . However , no r and omized trial has been conducted to find the best option . OBJECTIVE To compare the three most commonly used methods for treating appendiceal mass . METHODS Over a three-year period , 60 consecutive patients with appendiceal mass were r and omly allocated to three groups : Group A -- initial conservative treatment followed by interval appendectomy six weeks later ; Group B -- appendectomy as soon as appendiceal mass resolved using conservative means ; Group C -- conservative treatment alone . Short-term outcome measures included operative time , operative difficulty , postoperative complications , length of hospital stay , and duration of time away from work . Long-term outcome measures were : number of hospital visits made , presence of severe incisional pain , scar appearance , and patients with recurrent appendicitis . RESULTS Baseline characteristics were comparable in the three groups . In patients in Group A , operative time was less , adhesions were encountered less frequently , the incision had to be extended less often and post-operative complications were fewer , as compared to Group B. Patients in Group C had the shortest hospital stay and duration of work-days lost ; only 2 of 20 patients in this group developed recurrent appendicitis during a follow-up period of 24 - 52 ( median 33.5 ) months . CONCLUSION Of the three treatment modalities compared , conservative treatment without subsequent appendectomy appears to be the best OBJECTIVE To assess the value of laparoscopy in the accurate diagnosis of appendicitis in women of child-bearing age . DESIGN Prospect i ve r and omised trial . SETTING University hospital , Kuwait . SUBJECTS 100 patients who fulfilled the inclusion criteria between July 1988 and March 1990 . INTERVENTIONS 50 patients were r and omised to have diagnostic laparoscopy followed by appendicectomy if necessary , and the other 50 to have immediate appendicectomy . MAIN OUTCOME MEASURES Avoidance of unnecessary appendicectomy , length of operating time , and length of stay in hospital . RESULTS 19 of 50 patients in the study group did not require appendicectomy ( 38 % ) . One patient required an emergency operation for an ectopic pregnancy . Of the remaining 30 , only 4 of the removed appendixes showed no histological abnormality ( 13 % ) . There were no complications of laparoscopy . CONCLUSION Laparoscopy is a safe and effective way of diagnosing acute appendicitis and should be used more often Although classic open surgery is simple , expeditious , and effective , it has some drawbacks , including wound sepsis , delayed recovery , operative difficulties , and possibility of unnecessary appendectomies for false appendicitis . The aim of this study was to assess the applicability and safety of laparoscopic appendectomy ( LA ) in a prospect ively r and omized trial . Seventy nonselective patients with suspected appendicitis were r and omized to laparoscopic ( n = 35 , 17 male ) or open appendectomy ( n = 35 , 15 male ) and operated on an emergency basis . Operative findings , operating time , postoperative complications , and length of hospital stay were compared . We found that LA is associated with a shorter hospital stay , fewer postoperative complications , and better diagnostic accuracy , and it is recommended as the procedure of choice for the diagnosis and management of acute appendicitis Background The acute appendicitis is the most common abdominal emergency , and the primary treatment has been appendicectomy . Antibiotics are started preoperatively and continued postoperatively as needed . Methods This prospect i ve study was carried out at Sher-i-Kashmir Institute of Medical Sciences , Soura , Srinagar , Kashmir , India to determine the role of antibiotics as the only treatment in acute appendicitis and the analgesic consumption needed . Total of 80 patients were included in the study with a duration of abdominal pain less than 72 h. Out of 80 patients , 40 patients received antibiotics intravenously for 2 days followed by oral treatment for 7 days , while another 40 patients considered as controls were r and omized to surgery . Results Patients managed conservatively were discharged within 3 days except for two— patients who required surgery after 12 and 24 h , respectively , because of peritonitis due to perforated appendicitis . Four patients were readmitted within 1 year as a result of recurrent appendicitis and had to undergo surgery when appendicitis was confirmed . The diagnostic accuracy within the operated group was 90 % . Two patients had perforated appendicitis at operation . Conclusion Our conclusion is that antibiotic treatment in the patients with acute appendicitis is quite effective , and these patients may not need surgery . The patients managed conservatively with antibiotics alone experience less pain and require less analgesia but have high recurrent rate 43 children between the ages of 7 and 15 years with clinical symptoms of acute appendicitis were r and omised to an open appendectomy ( OA ) or a laparoscopic appendectomy ( LA ) . There were 15 acute cases of appendicitis and 5 perforated appendices in the OA group and 17 acute appendicitis , 3 cases of perforated appendices and 3 other diagnoses in the LA group . The operative time was a little shorter in the OA group . There were no differences in hospital stay or the postoperative course of the patients . In the LA group , there were two minor complications , no other complications were seen . When comparing the two surgical methods in the consistent group of patients with non-perforated acute appendicitis no statistical differences were seen in the operative time , hospital stay or in the recovery of the patients between the OA and the LA groups . We conclude that LA has no significant benefit over OA in routine use . In paediatric patients we recommend an open approach for clinical ly typical acute appendicitis , but there should be no hesitation to choose laparoscopic approach when the clinical diagnosis is unclear BACKGROUND / PURPOSE Laparoscopic appendectomy is an accepted way of dealing with suspected uncomplicated appendicitis in children . The role of laparoscopy in complicated acute appendicitis is more controversial . The purpose of this trial was to compare laparoscopic appendectomy with open appendectomy in children with complicated appendicitis . METHODS A total of 102 children with suspected acute appendicitis were selected r and omly to undergo either a laparoscopic or an open appendectomy . The outcomes of 25 children with complicated appendicitis , 13 in the laparoscopic group and 12 in the open appendectomy group , were analyzed . Children , their parents , and research nurses were blinded to which procedure had been performed and remained blinded until the control visit 7 days after the operation . All 25 children completed a 30-day follow-up . RESULTS There were no differences in terms of patients ' age , sex , weight , height , and appendiceal histology between the 2 groups . All laparoscopic procedures were completed without conversion . The mean ( + /-SD ) operating time was 63 ( + /-31 ) minutes in the laparoscopic group and 37 ( + /-18 ) minutes in the open appendectomy group ( mean difference 26 minutes , 95 % CI 5 to 47 minutes , P = .02 ) . There were 2 major complications in the laparoscopic group in children with appendiceal masses . One child had an entero-cutaneous fistula of the residual appendiceal tip that needed open reoperation . Another child had a pelvic abscess that resolved with antibiotic treatment . Superficial wound infections were encountered in 2 patients in the open appendectomy group . CONCLUSIONS Laparoscopic appendectomy is an alternative to open procedure in children with complicated appendicitis . Good surgical judgement is necessary in patients with an established appendiceal abscess Abstract . A prospect i ve r and omized trial comparing laparoscopic appendectomy with open appendectomy in patients with a diagnosis of acute appendicitis was conducted between October 1992 and April 1994 . Of the 158 patients r and omized , 7 patients were excluded because of protocol violations ( conversion to laparotomy in 4 , appendix not removed in 3 ) . The 151 patients r and omized to either a laparoscopic ( n = 79 ) or an open appendectomy ( n = 72 ) showed no difference in sex , age , American Society of Anesthesiology ( ASA ) rating , or previous abdominal surgery . The histologic classification of normal , catarrhal , inflamed , suppurative , and gangrenous appendicitis was not different between the two groups . Conversion from laparoscopic to open appendectomy was necessary in seven patients ( 9 % ) who had advanced forms of appendiceal inflammation . When compared to open appendectomy the laparoscopic group had a longer median operating time ( 63 minutes versus 40 minutes ) , fewer wound infections ( 2 % versus 11 % ) , less requirement for narcotic analgesia , and an earlier return to normal activity ( median 7 days versus 14 days ) . There was no difference in morbidity , and both groups had a median time to discharge of 3 days . Laparoscopic appendectomy is as safe as open appendectomy ; and despite the longer operating time , the advantages such as fewer wound infections and earlier return to normal activity make it a worthwhile alternative for patients with a clinical diagnosis of acute appendicitis
The major primary outcomes show a high recurrence rate and failed treatment associated with the conservative management of appendicitis .
The other outcomes obtained show that there is an increased incidence of complications associated with operative management .
Economic implication s and cost-effectiveness analysis show that conservative treatment may be preferred .
The length of hospital stay was significantly higher in conservative approach to management ; however , shorter time off activities was observed .
Appendicectomy has been accepted as the gold st and ard for the management of appendicitis over the years , but there has been an increasing evidence and trend toward the conservative approach to the management of appendicitis .
The aim of this review is to search existing literature and to evaluate and compare the conservative and operative approaches to the management of appendicitis .