Related Experiment Videos
Non-operative versus operative management of uncomplicated acute appendicitis: a randomized controlled study in
Constance Cummings-John1,2, Abdulai Jawo Bah3, Aiah Lebbie4,5
1Department of Surgery, Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone. constance.cummings-john@usl.edu.sl.
Background:
Acute appendicitis is the leading cause of acute abdomen in young adults, typically managed by appendectomy. A growing body of evidence supports non-operative management as an alternative for uncomplicated cases. This study aimed to compare the effectiveness of non-operative management (NOM) versus operative management (OM) for uncomplicated acute appendicitis.
Methods:
A prospective, longitudinal, randomized controlled trial was conducted at Connaught Hospital, Sierra Leone. Sixty patients were randomized: 30 to NOM and 30 to OM. NOM patients received intravenous metronidazole and ceftriaxone for 48 h, followed by oral metronidazole and ciprofloxacin for 5 days. OM patients underwent open appendectomy. NOM patients were monitored for symptom resolution or progression; failure required appendectomy. Both groups were followed up on days 7, 10, 30, 60, and 90 post-admissions to assess recurrence, cost of care, and quality of life (QoL).
Results:
The median age was 26 years (IQR 14-42) for NOM and 27 years (IQR 18-54) for OM. Most patients were males (NOM: 66.7%, OM: 63.3%). Antibiotic treatment was successful in 18 (60%) NOM patients. Failure occurred in 12 (40%) NOM patients, 11 during the index admission, with 1 (3.3%) experiencing recurrence within a week of discharge. Successful NOM resulted in a significantly improved QoL score (5.98), a shorter mean hospital stays (4 days), a lower mean cost of care (NLe 482.29; $49.08), and no catastrophic health expenditure, compared to both OM and failed NOM. Statistically significant differences were observed in favor of successful NOM over surgery (including OM and failed NOM requiring surgery) for the cost of care and time to return to normal activities.
Conclusion:
NOM for uncomplicated acute appendicitis achieved a 60% success rate with a low recurrence rate (3.3%). It is associated with lower costs, reduced risk of catastrophic health expenditure, shorter hospital stays, faster return to normal activities, and improved QoL compared to operative management.
Trial Registration:
The Pan African Clinical Trials Registry (PACTR).
Clinical Trial Number:
PACTR202605655002550. Date of registration:20th April 2026. "Retrospectively registered".
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