DISCUSSION
Surgical method in the treatment of acute appendicitis still ranks first
in the world. As with all surgical treatments, there may be early or
late complications in appendectomy (10). Negative appendectomy rate is
around 40%, especially in fertile women (11). Conservative antibiotic
therapy in the treatment of uncomplicated AA is an ongoing discussion in
order to avoid negative appendectomy and postoperative complications.
The main reason for the discussion is the lack of sufficient information
about the long-term results of antibiotic treatment (12). Meta-analyses
show that antibiotic treatment has similar rates to surgical treatment
in terms of complications (4,13,14,15). In the study conducted by
Salminen et al., 273 patients diagnosed with acute appendicitis
underwent appendectomy, while 257 patients received antibiotic treatment
and the 5-year follow-up results were evaluated. Complication rate was
significantly higher in the surgical group. Appendectomy was performed
in 85 patients from the antibiotic group due to recurrent appendicitis,
and 7 of them were found to have negative appendectomy (4). In the study
conducted by Di Saverio et al., 20.7% (25/121) of the patients who were
treated conservatively during an average follow-up of 19 months required
surgical treatment (16). Literature data indicate that antibiotic
treatment should be discussed more seriously and effectively in the
treatment of uncomplicated AA (17). In our study, we evaluated whether
WBC, platelet count, MPV, PDW, RDW values in CBC and CRP are effective
in distinguishing patients who will be treated with surgery or
antibiotics in patients diagnosed with AA without complication with
clinical, radiological and laboratory data and undergoing laparoscopic
surgery and antibiotic treatment. CBC is a widely used, inexpensive and
effective laboratory parameter in the diagnosis of AA.
In the study conducted by Ishizuka et al., and in a separate study by
Boshnak et al, the mean age was found to be higher in patients diagnosed
with complicated AA compared to the uncomplicated group (6,17). These
data were consistent with our study. In our study, the mean age of the
LA group was higher than the medical treatment group.
The WBC value is the first to rise and the most commonly used laboratory
parameter in the diagnosis of AA (18). In our study, the WBC value was
high in both groups, but the difference between them was not
statistically significant.
In the study conducted by Park et al., patients who were diagnosed with
AA uncomplicated by CT were divided into two groups. While antibiotic
treatment was given to one group, the other group was not given medical
or surgical treatment. After 19 months of follow-up, 20% of the
patients in the antibiotic group and 23% of the patients in the other
group required surgical treatment (19). In our study, recurrent
appendicitis was not observed in the group treated with antibiotics
during the 12-month follow-up.
The studies conducted revealed the relationship between inflammation and
platelet value. During the inflammation process, the number of platelets
decreases, especially in septic conditions (20). Platelet size
correlates with activity; large platelets are young and active (21). In
the study conducted by Boşnak et al., the mean platelet value was found
to be statistically significant between uncomplicated AA and complicated
AA groups (6). In the present study, the platelet value was found to be
higher in the LAA group compared to the medical treatment group.
MVP is the mean size of platelets in the blood and is calculated by
dividing thrombocytocrites by the number of platelets (22). Different
results have been obtained in studies on the correlation between MVP and
AA. In the studies performed by Saxena et al. and also Ceylan et al.,
MPV value was found to be low in patients diagnosed with AA (23,24). In
some studies, it was found higher compared to those of the control group
(25). In the study conducted by Fan et al., no relationship was found
between MVP and AA (26). In our study, there was no significant
difference between the surgical group and the medically treated group.
PDW is the measure of the width of the platelet size distribution.
Studies have shown that PDW is associated with many diseases. In the
study conducted by Yang et al., PDW value was found to be higher in
severe preeclampsia compared to mild preeclampsia (27). In the study
conducted by Albayrak et al., PDW value was found to be higher in AA
patients compared to the control group (28). In the study conducted by
Fan et al. PDW value was found to be higher in gangrenous appendicitis
compared to the control group (26). In the study conducted by Bosnak et
al., PDW value was found to be associated with AA (6). In our study, PDW
value was found to be higher in the LA group than the medical treatment
group.
RDW is used in the differential diagnosis of the cause of anaemia. It
indicates the heterogeneity of red blood cells. In inflammatory
conditions such as inflammatory bowel diseases, acute pancreatitis and
sepsis, an increase in RDW values can be observed. Studies have shown
that there is a relationship between RDW and inflammatory markers CRP,
erythrocyte sedimentation rate and interleukin-6. Circulating
inflammatory mediators suppress erythrocyte maturation. Therefore,
larger reticulocytes entering the circulation lead to an increase in RDW
(29). In the study conducted by Narcı et al., RDW value was found to be
significantly lower in patients with AA diagnosis compared to the
control group. They stated that RDW was higher in chronic inflammations
rather than acute inflammation (30). In the study conducted by Boşnak et
al., RDW value was found to be higher in the complicated AA group
compared to the non-complicated group (6). In our study, the RDW value
of the group treated with LAA was found to be higher than the group
treated with antibiotics.
The C-reactive protein is an acute phase reactant. Its value increases
in correlation with the severity of inflammation (31). Studies have
found that CRP has a high sensitivity in the diagnosis of AA (32). These
findings are compatible with our study. In the present study, the CRP
value was found to be high in patients with AA, but there was no
difference between the surgery group and the medical group.