Effect Of Endoscopic Appendix Intubation And Irrigation On Acute Non-complex Appendicitis

Objective: To investigate the efficacy and safety of endoscopic appendix intubation and irrigation on non-complicated appendicitis,and to prospective non-randomized concurrent controlled study with laparoscopic appendectomy(LA)and antibiotic conservative treatment.Methods: Prospective analysis of clinical data from 169 patients admitted to our hospital from October 2015 to October 2017 who underwent colonoscopy or laparoscopic treatment or conservative antibiotics for acute appendicitis.According to the non-randomized concurrent trial,169 patients were divided into one experimental group and two control groups,including endoscopic appendix intubation and irrigation group(group EAI)(n=18),laparoscopic treatment group(group LA)(n=87),and antibiotic treatment group(group A)(n=64).The treatment success rate,hospital stay,medical costs,operation time,abdominal pain relief time,fasting time,complication rate and recurrence rate were analyzed.Results: There were no significant differences in the pre-treatment basic characteristics of age,gender,abdominal pain,fever,Alvarado score,white blood cell count,neutrophil count,and lymphocyte count(P>0.05).44.4%(8/18)of the EAI group were out patients,while the pre-treatment fever was accounted for 27.8%(5/18).All patients in EAI group were repeatedly flushed with saline after successful intubation in the appendix,while 55.6%(10/18)of them were treated with pus drainage.In EAI group,fecal or fecal stone were rinse out in 11.1%(2/18)of the patients,while the duration of abdominal pain relief,average fasting,operation,and hospital stay were 4.5(2.8-21.3)hours,0.67 days,30(25-31)minutes and 1.6(0.0-7.5)days,and the medical expenses were ￥3869(750-8080);recurrence rate was 22.2%(4/18),and average recurrence time was 6.25 months after surgery.In LA group,the duration of abdominal pain relief,average fasting,operation and hospital stay were 72(48-72)hours,2(1-2)days,60(45-75)minutes and 5.0(4.0-6.0)days,and the medical expenses were ￥12195(1244-13419).In A group, the duration of abdominal pain relief,average fasting and hospital stay were 84.0(72.0-120.0)hours,1.0(0-1.0)days,5.0(4.0-7.0)days,and the medical expenses were ￥4252(3260-5591).Comparing to LA group,the duration of hospital stay in EAI group showed a slightly declining trend(P=0.06),while the medical expenses,the duration of operation,average fasting and abdominal pain relief were decreased(P<0.05).There were no significant differences in the duration of average fasting,recurrence rate,medical expenses and antibiotic course between EAI group and A group(P>0.05).In EAI group,the duration of abdominal pain relief,hospital stay and intravenous antibiotics were shorter when compared to the A group(P<0.05).No complications occurred in EAI group and A group,while 3.4%(3/87)of the LA group occurred surgery-related complications.Conclusion: Endoscopic appendix intubation and irrigation is a safe and effective treatment for acute non-complex appendicitis.In endoscopic appendix intubation and irrigation,the duration of abdominal pain relief and hospital stay were shorter when compared to the LA or antibiotic conservative treatment.