Background: Management of appendicular mass is still controversial. Some authors plead for an initial non-operative approach followed by a delayed appendectomy.
Objectives: Our aim has been to revise the usefulness of this management and the optimal time to carry out the appendectomy.
Methods: We made a retrospective review of all the appendicular mass cases treated in our hospital during the last 8 years. We analyzed the success rate of the non-operative approach, the interval until the delayed appendectomy was performed, difficulty found at surgery and the occurred complications.
Results: Our series includes 19 appendicular mass cases managed initially by a non-operative approach. Intravenous antibiotics were administered to all of them and in 14 cases a peritoneal drainage was placed (the average length of stay was of 11.5 days). In 3 cases (16%) early appendectomy was performed (12, 30 and 40 days after the onset of the symptoms). In 16 (84%) the conservative approach succeeded and the appendectomy was delayed 3-12 months (average: 6.6 months). Four of them were performed by an open approach and 12 by laparoscopy (in 3 of which conversion was needed). The average length of stay was of 1.8 days, with only one complication (wound abscess). Of these 16 delayed appendectomies, 11 were not technically difficult to perform (average wait of 5.5 months) and in 5 cases the procedure was difficult due to multiple adhesions (average wait of 9.4 months).
Conclusion: Conservative management of appendicular mass is useful, with a success rate of 84% in our series. The appendectomy was less hazardous if performed 3-6 months after the onset of the symptoms.