Treatment of appendiceal mass: prospective, randomized clinical trial.

BACKGROUND: Appendiceal mass may be treated in several ways. However, no randomized trial has been conducted to find the best option. OBJECTIVE: To compare the three most commonly used methods for treating appendiceal mass. METHODS: Over a three-year period, 60 consecutive patients with appendiceal mass were randomly allocated to three groups: Group A--initial conservative treatment followed by interval appendectomy six weeks later; Group B--appendectomy as soon as appendiceal mass resolved using conservative means; Group C--conservative treatment alone. Short-term outcome measures included operative time, operative difficulty, postoperative complications, length of hospital stay, and duration of time away from work. Long-term outcome measures were: number of hospital visits made, presence of severe incisional pain, scar appearance, and patients with recurrent appendicitis. RESULTS: Baseline characteristics were comparable in the three groups. In patients in Group A, operative time was less, adhesions were encountered less frequently, the incision had to be extended less often and post-operative complications were fewer, as compared to Group B. Patients in Group C had the shortest hospital stay and duration of work-days lost; only 2 of 20 patients in this group developed recurrent appendicitis during a follow-up period of 24-52 (median 33.5) months. CONCLUSION: Of the three treatment modalities compared, conservative treatment without subsequent appendectomy appears to be the best.