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Leaving no stone unturned: Impact of appendicolith and characteristics on long-term recurrence after non-operative
Amram Kupietzky1, Yehonatan Bar-Moshe2, Nofar Lavie3
1Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91240, Israel. amramkupietzky@gmail.com.
Background:
Non-operative management (NOM) for uncomplicated acute appendicitis (AA) has been gaining popularity in recent years. One of the major concerns with NOM is the recurrence rate of AA following NOM.
Aim:
To investigate the impact of the presence of an appendicolith and its specific characteristics on the recurrence rate of AA following NOM.
Methods:
A retrospective analysis identified all patients treated with NOM for AA, at our institute between 2016 and 2024. Patients with an appendicolith on imaging were identified and their course and outcomes were compared with patients who were treated with NOM without an appendicolith. The primary outcome was defined as a recurrence of AA.
Results:
During the study period, 797 patients were treated with NOM for AA. Their mean age was 25.4 years ± 14.4 years, and 45.4% were females. Only 68 patients (8.5%) had an appendicolith identified on imaging. Patients with an appendicolith had a larger appendix diameter (10.2 mm ± 4 mm vs 8.5 mm ± 2.1 mm, P = 0.001). There was no difference in the recurrence rate of patients with and without an appendicolith (26.5% vs 19.1%, P = 0.14), however patients with an appendicolith presented with a shorter time to recurrence of appendicitis (3.9 months ± 10.4 months vs 5.9 months ± 8.1 months, P = 0.04). In a sub analysis, the number of appendicoliths, its size, and its location, did not influence the recurrence rate.
Conclusion:
This study demonstrates that patients with appendicoliths have a shorter time to recurrence after NOM of AA, but do not experience higher overall recurrence rates.
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