Early surgery in appendicular mass: Surgical techniques and morbidity

It is unclear whether early appendicectomy prevents complications compared to delayed appendicectomy in patients with appendiceal mass (AM).To evaluate early surgical techniques for AM in terms of the evolution and morbimortality, a prospective comparative analysis of patients undergoing early surgery for AM using different surgical techniques was performed.A total of 102 patients with AM (mean age 59 years) were reviewed. The common site of appendiceal perforation was the base in 54 patients (52.9%). The surgical techniques used were primary closure plus omental patch in 42 patients (41.2%), conventional appendectomy in 41 patients (40.2%), ileocecectomy resection in eight patients (7.8%), primary closure plus ileostomy in six patients (5.9%) and right hemicolectomy in five patients (4.9%). Drainage was placed in the pelvic cavity in all patients, and the average length of stay was six days. The most frequent early, postoperative, and systemic complications were fever (n=48, 47%), seroma (n=35, 34.3%), and nosocomial pneumonia, (n=49, 48%). Seven patients (6.8%) were readmitted, and three required reoperation (2.9%). The surgical technique associated with the highest mortality was ileocecectomy (2%), and the technique most associated with early, postoperative, and systemic complications was primary closure plus omental patch (40%, 35%, and 27%, respectively). The 30-day mortality rate was 3.9%.Some surgical techniques had higher morbidity and mortality rates, and may affect the evolution of patients with AM, although the association was not significant. Our study suggests that certain surgical techniques may affect the evolution of patients with AM.