[Efficacy and safety of endoscopic direct-vision appendicitis therapy in patients with acute appendicitis]

Objective: To analyse the efficacy and safety of endoscopic direct-vision appendicitis therapy (EDAT) in patients with acute appendicitis. Methods: The clinical data of patients diagnosed with acute appendicitis and underwent surgical treatment from May 2023 to July 2024 at Zhongda Hospital of Southeast University were analysed retrospectively. The patients were divided into EDAT group (41 cases) and laparoscopic appendectomy (LA) group (630 cases) according to the surgical methods. After 1∶2 propensity score matching (PSM) based on general baseline information, Alvarado score and underlying diseases, the perioperative period and prognosis indicators were compared between the 2 groups. The deadline for follow-up was October 30, 2024. Results: A total of 123 patients were included after PSM, 41 patients in EDAT group, including 21 males and 20 females, aged [M (Q₁, Q₃)] 55 (37, 61) years; and 82 patients in LA group, including 41 males and 41 females, aged 50 (35, 60) years. A total of 366(221, 492) days were followed up. The operative time [ (38.7±22.3) vs (54.8±16.2) min], postoperative intestinal function recovery time [(2.5±1.3) vs (21.8±5.0) h], duration of antibiotic use [2 (2, 2) vs 3 (3, 4) d] and hospitalisation days [2 (1, 2) vs 3(2, 4) d] in EDAT group were shorter than those in LA group; postoperative visual analogue scale (VAS) score at 6 hours [(3.2±1.3) vs (5.5±1.2) scores] was lower than that in LA group; the proportion of patients with intraoperative bleeding >20 ml [0 vs 61% (50/82)] and proportion of painkiller use [7.3% (3/41) vs 69.5% (57/82)] were lower than those of LA group (all P<0.001). The rate of postoperative recurrence in EDAT group was higher than that in LA group [4.9% (2/41) vs 0, P=0.035]. Conclusion: EDAT is effective and safe in treating patients with acute appendicitis, but patients are at risk of recurrence.