Ochsner-Sherren rejimi halen apendiküler kitle tedavisinin düzenlenmesinde geçerli midir?

AMAÇ
Her ne kadar, 1901 yýlýna kadar uzanan bir geçmiþte önerilen yaklaþým olmakla birlikte, apendiküler kitleye yönelik konservatif tedavi halen yaygýn þekilde uygulanmaktadýr. Apendiküler kitle ile ilgili erken apendektominin avantajlarý konusunda bilgi veren son zamanlarda yapýlmýþ az sayýda seriyle birlikte, bu retrospektif çalýþmada hastalara bu tip yaklaþýmýn yapýlabilirliði araþtýrýldý.
GEREÇ VE YÖNTEM
Ocak 2005 ile Aralýk 2007 arasýnda þüpheli apandisit ve apendiküler kitle nedeniyle acil apendektomi uygulanan 506 hasta (240 erkek, 266 kadýn) geriye dönük olarak deðerlendirildi. Subakut/kronik apandisiti bulunan ve interval apendektomi uygulanan hastalar çalýþma dýþýnda tutuldu. Ameliyat sonrasý sonuçlar, apendiküler kitlesi bulunan ve bulunmayan hastalardan oluþan iki grup arasýnda karþýlaþtýrýldý.
BULGULAR
Çalýþmaya, 114’ünde apendiküler kitle bulunan toplam 506 hasta alýndý. Ýki grup karþýlaþtýrýldýðýnda, her iki grupta da hiçbir majör komplikasyon saptanmadý. Apendiküler kitlesi bulunan hastalardan oluþan grupta minör komplikasyon insidansý anlamlý þekilde artarken, yara enfeksiyonu insidansý bakýmýndan iki grup arasýnda anlamlýlýk saptanmadý. Apendiküler kitlesi olan hastalarda, anlamlý þekilde yüksek dren kullanýmý/hastanede kalma süresi olduðu saptandý.
SONUÇ
Düþük morbidite, azalan hastanede kalma süresi, düþük maliyet ve hasta uyumu, Hindistan gibi bir ülkede özellikle yaygýn olan ve benzer bulgularla baþvuran intestinal/peritoneal tüberküloz gibi olgularý atlamaksýzýn, apendiküler kitleye yönelik erken cerrahi tedaviyi desteklemektedir.

Does Ochsner-Sherren regimen still hold true in the management of appendicular mass?

BACKGROUND
Although proposed as far back as 1901, conservative management for appendicular mass is still widely practiced. With a few recent series outlining the advantages of early appendicectomy for appendicular mass, we tried to investigate the feasibility of such an approach in this retrospective study.
METHODS
We analyzed retrospectively 506 patients (240 male, 266 female) who underwent emergency appendicectomy for suspected appendicitis and appendicular mass between January 2005 and December 2007. Patients with sub-acute/chronic appendicitis and interval appendicectomy were excluded. The postoperative outcomes were compared between the two groups of patients classified as with or without the mass.
RESULTS
A total of 506 patients were included in the study, of which 114 had appendicular mass. A comparison of the two groups demonstrated no major complications in either group. There was significantly increased incidence of minor complications in the group of patients with mass, although the incidence of wound infection showed no significance difference between the two groups. There was a significantly increased usage of drain / duration of stay in patients with mass.
CONCLUSION
Low morbidity, reduced hospital stay, low cost, and patient compliance favor early operative management for appendicular mass, and it also avoids the possibility of missing entities like intestinal/peritoneal tuberculosis, which have similar presentations and are especially common in a country like India.