Endoscopic direct-vision therapy for acute uncomplicated appendicitis: a retrospective study

Acute uncomplicated appendicitis is common. Laparoscopic appendectomy (LA) is definitive but invasive, while endoscopic retrograde appendicitis therapy (ERAT) carries radiation risks. Endoscopic direct-vision appendicitis therapy (EDAT), an ultra-minimally invasive organ-preserving technique, lacks clarity on patient selection, long-term recurrence, and clinical applicability.

To explore EDAT's short-term efficacy, safety, and applicable population via comparison with LA, and contextualize it within existing evidence.

A retrospective study (Dec 2023-Dec 2024, Zhejiang Hospital) included 41 EDAT and 46 LA patients. Clinical indicators, serum inflammatory factors (WBC, CRP), recurrence, and complications were compared; subgroup (gender/age) and correlation analyses were performed.

Baseline characteristics (sex, age, follow-up time) were balanced between the two groups (P > 0.05). Compared with LA group, EDAT group had significantly shorter operation time [(35.37 ± 10.48) min vs. (53.54 ± 7.91) min], faster abdominal pain relief [12.00 (12.00, 24.00) h vs. 60.00 (60.00, 72.00) h], earlier resumption of oral intake [6.00 (6.00, 12.00) h vs. 24.00 (12.00, 24.00) h], and better postoperative inflammatory control (postoperative WBC: 6.83 ± 1.39 vs. 7.62 ± 2.13 × 10⁹/L; postoperative CRP: 7.89 ± 2.98 vs. 19.90 ± 11.30 mg/L). The mean postoperative hospital stay in EDAT group was 3.00 (2.00, 3.50) days, and 3 patients (7.32%) developed recurrence during 1-13 months of follow-up (mean 7.88 ± 3.52 months). Subgroup analysis showed consistent efficacy of EDAT across genders and age groups.

Endoscopic direct-vision appendicitis therapy is a feasible, safe ultra-minimally invasive alternative for selected patients, outperforming LA in symptom relief and inflammation control. However, single-center, small-sample, and short follow-up limit conclusions; large-scale prospective studies with 1-3 years of follow-up are needed.