Evaluation of the Effectiveness and Safety of Non-Operative Treatment for Uncomplicated Acute Appendicitis in Adults at the mixed hospital in Laghouat over a period of six months : A Prospective Cohort Study.

Abstract

Title: Evaluation of the Effectiveness and Safety of Non-Operative Treatment for Uncomplicated Acute Appendicitis in Adults at the mixed hospital in Laghouat over a period of six months: A Prospective Cohort Study. Background: Appendectomy has long been the gold standard treatment for acute appendicitis. However, increasing evidence from randomized controlled trials suggests that non-operative treatment (NOT) based on antibiotic therapy may represent a safe and effective alternative for uncomplicated acute appendicitis (UAA) in carefully selected patients. This study aimed to evaluate the effectiveness and safety of NOT for UAA in adults at the Colonel Lotfi Mixed Hospital of Laghouat, Algeria. Methods: A prospective cohort study was conducted including 36 adult patients (≥15 years) diagnosed with UAA between August 20, 2025, and February 20, 2026. Diagnosis was based on clinical, biological, and radiological criteria (Alvarado score <7, leukocytosis <15,000/mm³, appendiceal diameter 6–10 mm, absence of appendicolith or complications). Patients received intravenous antibiotics for 48 hours followed by oral therapy to complete a 10-day course using one of two regimens: Protocol 1 (cefotaxime + metronidazole) or Protocol 2 (amoxicillin-clavulanate + metronidazole). Patients were monitored clinically and biologically during hospitalization, with follow-up at 1 and 6 months. Treatment failure was defined as the need for appendectomy during the initial hospitalization. Statistical analysis was performed using SPSS v27.0. Results: The mean age was 29.94 ± 13.41 years, with a male predominance (58.3%). The overall success rate of NOT was 77.8% (28/36), while 22.2% (8/36) required surgical intervention. Protocol 2 showed a higher success rate compared to Protocol 1 (85.7% vs. 66.7%), although the difference was not statistically significant (p = 0.236). Abdominal defense was the only factor significantly associated with treatment failure (p = 0.028). No severe complications were observed among successfully treated patients. Conclusion: Non-operative treatment appears to be a safe and effective first-line option for selected adults with UAA, with a success rate comparable to that reported in the literature. Careful patient selection, close monitoring, and prompt surgical intervention in case of failure are essential to ensure optimal outcomes. Larger multicenter studies with longer follow-up are required to validate these findings and establish standardized treatment protocols.