Evaluation of Early Surgical intervention Versus Conservative Management of Appendicular Mass

Background: The complications of appendicitis with an appendicular mass put the surgeon in a dilemma. Some state that appendectomy should be done early, while others advocate for starting with conservative management. The superiority of either protocol is a matter of debate, with contradictory reports. This study was performed to assess the feasibility and safety of immediate appendicectomy versus interval appendectomy. Patients and methods: This is a randomized controlled trial that included patients who presented with an appendicular lump. The study patients were equally randomized into two groups: Group A, where patients were scheduled for early surgical invention, and Group B, where patients were planned for initial conservative management followed by an interval appendectomy. Results: This work included 32 patients who were equally enrolled in Group A and Group B. All patients in the two groups underwent appendectomy without the need for additional bowel resection. The median length of stay was 2.5 days in Group A and 9.5 days in Group B (p < 0.001). The mean days to normal activity were 3.5 ± 1.37 in Group A and 6.56 ± 3.12 in Group B (p = 0.001). The total number of patients with complications was 3 in Group A (18.75%) and 5 in Group B (31.25%), with a statistically non-significant difference (p = 0.414). No cases of bowel injury or fecal fistulae were encountered in either group. Conclusion: This study supports the safety and efficacy of immediate appendicectomy, demonstrating a significantly shorter hospital stay, faster recovery, and comparable overall complication rates.