Operative Outcomes of Patients With Recurrent Uncomplicated Appendicitis are Similar to Patients With Acute Uncomplicated Appendicitis

Introduction: Nonoperative management (NOM) for uncomplicated acute appendicitis (AA) has been gaining popularity in recent years. As so, more patients present with recurrent AA after a successful past episode of NOM. The aim of this study is to assess the outcomes of patients who underwent appendectomy due to recurrent uncomplicated AA after a successful episode of NOM in the past, and to compare their operative and postoperative course to patients operated for uncomplicated AA during their index admission. Methods: A retrospective analysis identified patients who underwent appendectomy in our institution between 2017 and 2022. The study group included all consecutive patients who underwent an appendectomy due to recurrent uncomplicated AA after NOM for uncomplicated AA in the past. Their course and outcomes were compared to a cohort of consecutive patients without any prior episodes of AA, who underwent an appendectomy during their index admission. Results: During the study period, 102 patients underwent an appendectomy due to recurrent uncomplicated AA. This group was compared to 107 consecutive patients without prior episodes of AA, who underwent upfront surgery during their index admission. Analysis demonstrated no significant difference between the groups in the operative approach, resection-technique, overall postoperative complication rates, the use of peritoneal drains, and intraoperative findings. However, length of surgery was significantly shorter in the recurrent AA group than in the upfront appendectomy group (mean ± standard deviation, 34 ± 13.7 versus 50.7 ± 18 min; P < 0.001). Pathology analysis revealed a normal appendix in 11.8% of patients presenting with recurrent AA compared to 1.9% of patients in the upfront surgery group (P = 0.007). Conclusions: This study demonstrates that surgery for recurrent uncomplicated AA after a successful episode of NOM appears to be safe and comparable to upfront surgery during the index admission for uncomplicated AA.