A comparative study of conservative management versus surgical management in the first episode of acute appendicitis: Outcomes and recurrence

Background: Appendectomy is the gold standard for acute appendicitis, but antibiotic-first management is an alternative for uncomplicated cases. Aims and Objectives: The aim of this study was to compare outcomes of conservative versus surgical management in first-episode uncomplicated acute appendicitis. Materials and Methods: This prospective comparative observational study enrolled 78 patients (aged 18–60) divided equally into conservative (intravenous/oral Ceftriaxone+Metronidazole, n=39) and surgical (n=39) cohorts. Follow-up was at 2 weeks, 3 and 6 months. A pre-specified stratified analysis evaluated patients with an Alvarado score ≥6. Results: Baseline characteristics were comparable, though the surgical arm had higher baseline Alvarado scores (≥8 in 66.7% vs. 7.7%, P<0.001). Surgery achieved 100% success versus 79.5% for conservative management (20.5% failure, P=0.005). Recurrence at 6 months was 7.7% in the conservative group (P=0.24). Surgical patients reported lower Day-3 pain (2.92 vs. 4.36, P<0.001), shorter hospital stays (3.97 vs. 4.56 days, P=0.02), faster return to activity (5.64 vs.7.13 days, P<0.001), and higher satisfaction (8.95 vs. 7.97, P<0.001). Wound infections occurred only after surgery (7.7%). In the Alvarado score ≥6 stratum, these outcome differences remained statistically significant (P≤0.016). Conclusion: Appendectomy achieved higher cure rates, faster recovery, and no recurrence. Although conservative management succeeded in most patients, it carried higher failure and recurrence risks. Due to non-randomized allocation, these findings are hypothesis-generating.