Abstract
Introduction: Early during the COVID-19 pandemic, the royal college of surgeons advised to use Non-Operative Treatment of appendicitis
NOTA or otherwise open surgery for appendicitis. This study has explored the resulted management differences, and the outcome after one year
follow up.
Methods: Retrospective study covering Pre-pandemic data over March-May,2019 & COVID-19 pandemic data over March-May,2020. We
compared the outcome of non-operative treatment approach (NOTA), open and laparoscopic surgical outcome between the 2 groups.
Results: The number of admissions was lower in the COVID compared to the Pre-COVID Group (35 vs 43).
In the COVID group had more CT scanning of the abdomen and pelvis (65.7% vs 42.2%; p=0.036). There was no difference in the diagnostic value
for these imaging methods between the 2 groups (87.5% vs 86.6%)
During COVID period Signicantly fewer patients underwent surgery (77.1 vs 92.8; p<0.04), There were signicantly more complicated
appendicitis cases in the COVID group compared to Pre-COVID group (59.2 vs 28.2; p:0.021). There was in reduction LOS when comparing
Laparoscopic to NOTA (1.7 vs 2.6 days; p:0.03). There has been higher complication rate in the open and NOTA treatments compared to
Laparoscopic, but this was not statistically signicant (24.3 % vs 14.8%; p: 0.29).
In the NOTA group 41 % of the patients had emergency or interval appendectomy in after one year follow up period.
Conclusions: There was a tendency towards conservative approach/open surgery during the pandemic. Our study suggests that Laparoscopic
surgery should remain the preferred method of management of appendicitis during COVID-19 pandemic considering the more complicated
appendicitis. NOTA should be limited to selected high risk patients. accepting the risk of disease recurrence and need for further interval or
emergency surgery