selleckchem a meta-analysis was published comparing conservative treatment (i.e., antibiotic therapy +/− percutanteous abscess drainage) to appendectomies in the treatment of complicated appendicitis (cases exhibiting abscesses or phlegmon) . 17 studies (16 non-randomized/retrospective and 1 non-randomized/prospective) reported clinical data for 1572 patients: 847 patients received conservative treatment and 725 underwent acute appendectomies. Conservative treatment was associated with significantly fewer complications, wound infections, abdominal/pelvic abscesses, ileal/bowel obstructions, and additional follow-up surgeries. No significant differences were found in the overall length of hospitalization or in the duration of intravenous antibiotic infusion. Overall, several clinical studies demonstrated that there were significantly fewer complications in the conservative treatment group than there were in the appendectomy group. The authors concluded that conservative treatment of complicated appendicitis was
associated with decreased complication rates and CP868596 fewer repeat surgeries (“re-operations”) compared to traditional appendectomies, while both treatments featured comparable lengths of hospitalization. Traditional management is initially conservative followed by interval appendectomies performed after resolution of the mass. Recently, the efficacy of interval appendicectomies has been called into question, and there is disagreement in the medical community regarding whether or not the procedure is appropriate for adults with appendiceal abscesses. The main dispute involves the recurrence and complication rates following interval appendectomies as well as the procedure’s ability to address underlying malignancy. The literature provides little evidence that an interval appendicectomy is routinely necessary; findings instead demonstrate that the procedure is unnecessary in 75%-90% of cases [40–42]. The results of a review by Andersonn and Petzold  based
primarily on retrospective studies supported the practice of nonsurgical treatment without interval appendectomies in patients with appendiceal abscesses or phlegmon. Pomalidomide order Appendiceal abscesses or phlegmon were found in 3.8% of patients with appendicitis. Nonsurgical treatment failed in 7.2% of these cases, and abscess drainage was required in 19.7%. Immediate surgery was associated with higher morbidity rates compared to nonsurgical treatment. After successful nonsurgical treatments, malignancy and serious benign diseases were detected in 1.2% and 0.7% of cases, respectively, during follow-up analyses. Following successful conservative treatment, interval appendicectomies were only performed for patients with recurrent symptoms.