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.