Interval Appendectomy Operative vs. Non-Operative Management of Appendicitis in Saudi Arabia

The goal of this review is to analyze the perfect mechanism for managing acute appendicitis. Both surgical and non-operative approaches are in contention as the best remedies for the appendix complications. To draw a better comparative analysis, the strengths and weaknesses of each proposed mechanism are analyzed. In the Kingdom of Saudi Arabia (KSA), both immediate and interval surgical procedure remain debatable as best remedies for acute appendicitis. To determine the suitability of both immediate and interval appendectomy against non-operative management in KSA, vast literature is analyzed to portray the strengths of each medical maneuver.
Background: The primary objective of appendicitis management is to ensure early diagnosis and prevent operative management, which is risky and costly ^[1]. However, this goal has remained elusive due to delayed diagnosis, a characteristic that is prevalent for most people. In an analysis concerning the changing trends of appendicitis management over the past 30 years, surgery is not the only remedy for appendicitis patients ^[2]. Some individuals, as exhibited by numerous studies, have been able to recover without the need for surgical procedures, currently conceptualized as appendectomy. However, concentrating on the analysis by a number of scholars, it becomes evident that some delayed attention to symptoms, mainly due to patient’s ignorance, makes appendectomy inevitable. As such, the most common cause of abdominal surgical emergency is appendicitis ^[3]. Narrowing down to the ground situation in America, not much difference is exhibited. Appendectomy remains the most significant tool at the physicians disposal when faced with relatable appendicitis dilemmas. By the time patients seek medical attention, it is already late, an aspect that motivates physicians to put into use prompt surgical procedures.
The growing attention to appendicitis management is proportional to its prevalence rate. Appendicitis accounts for approximately 40,000 hospital admissions each year in England ^[2]. Similarly, early studies performed by English medical scholars indicated that close to 150 people from England and Wales die from acute appendicitis ^[4]. The prevalence rate of appendix complications is approximately seven to eight percent of the global population. Regardless of the advanced diagnostic and surgical technology, morbidity of the complication is 10%, and the mortality rate is between 1% and 5%. Despite its high prevalence, acute appendicitis is decreasing the in the US and the European region while proportionally increasing in the developing countries, mainly due to changing lifestyles ^[5,6,7].Consequently, a histopathological study on KSA in 2015 revealed that diagnosis rate of acute appendicitis was 52% while acute suppurative, acute gangrenous appendicitis and acute perforated appendicitis remained at 28%, 12.5% and 2% respectively ^[8]. However, it is important to acknowledge that the study was limited to one geographical area, but scientifically, the figures represent a consistent pattern. Significantly, the prevalence rate of subhepatic acute appendicitis accounted for 0.054% of Saudi Arabia’s hospital population ^[9]. With much research being carried on the best way of handling appendicitis, this next segment of the review covers a summary of current research’s perception concerning the effective medical procedure (operative vs. non-operative). The summary section is not conclusive but rather shows a sample of analyses approaching the best way of handling appendix complications in the general population.
      Methods:A review of the literature was made using the most common electronic sources including: electronic database, EMBASE, MEDLINE search using