Clinical Outcomes of Early Versus Interval Appendicectomy in Appendiceal Mass: A Study of 100 Patients

Background: Appendiceal mass is a well-recognized complication of delayed or progressive acute appendicitis, commonly seen when inflammatory response results in a localized phlegmon or abscess. Management remains controversial, with two primary strategies widely practiced: Early Appendicectomy (EA) performed at initial presentation, and Interval Appendicectomy (IA) following initial conservative treatment and delayed elective surgery. International variability in resource settings, surgeon preference, and diagnostic availability contributes to the ongoing debate over optimal care.

Objective: To compare clinical outcomes of EA and IA in patients presenting with appendiceal mass, with particular focus on operative difficulty, postoperative complications, hospital stay, recurrence, and overall morbidity.

Methods: A prospective observational study was conducted on 100 patients aged ≥15 years diagnosed with appendiceal mass at Dept. of Urology, Dinajpur Medical College andHospital, Bangladesh from January 2023 to December 2024. Patients were grouped into EA (n=50), who underwent surgery within 24–72 hours of admission, and IA (n=50), managed initially with antibiotics and supportive care followed by elective appendicectomy 6–8 weeks later. Data collection included demographic profile, operative findings, complication rates, recurrence during waiting period, and length of hospital stay. Statistical analysis was performed using SPSS version 25, with significance determined at P < 0.05.

Results: Operative difficulty was significantly higher in the EA group, with 82% demonstrating dense adhesions and 14% requiring conversion to open surgery. IA patients showed fewer operative complications (4% vs. 16%), shorter total hospital stay (5.8 ± 1.9 vs. 7.4 ± 2.3 days), and lower postoperative wound infection rate (6% vs. 12%). Recurrence occurred in 10% of IA patients during conservative waiting, though most were managed medically.

Conclusion: Interval appendicectomy following initial conservative therapy is associated with reduced operative morbidity, shorter recovery time, and easier surgical dissection, making it a preferable strategy in most cases. Early appendicectomy may be reserved for selected patients demonstrating clinical deterioration or failure of conservative management.

Keywords: Appendiceal Mass, Acute Appendicitis, Early Appendicectomy, Interval Appendicectomy, Conservative Management, Operative Morbidity, Hospital Stay, Recurrence, Postoperative Complications, Surgical Outcomes.