M.G. Kenjaev, MD, PhD, A.M. Kenjaev, Medical Center of the Kyrgyz State Medical Academy, Bishkek, Kyrgyz Republic (Director – T.T. Kasymbekov, MD, PhD) Abstract. The article presents the results of the examination and surgical treatment of 250 patients admitted with suspected acute appendicitis. Of these, 130 underwent surgery. The effectiveness of ultrasound and acupuncture in determining surgical treatment tactics is demonstrated. In modern conditions, strict requirements are placed on the diagnosis of acute appendicitis: timely recognition of the destructive process is not enough; it is equally important to avoid unnecessary surgery in cases where there is no destruction. For many decades, despite the doctrine of "early surgery," attempts have been made to somehow change the treatment tactics for simple appendicitis [3,5,7], but the entire problem lies in the difficulty of preoperatively determining the various morphological forms of acute appendicitis. In recent years, this has become possible to some extent thanks to the introduction of laparoscopy into clinical practice [1,4,6]. However, this research method is not yet available for widespread use and is an invasive method with well-known disadvantages. In this regard, sonography is the preferred method, but unfortunately, it has not yet found widespread use due to the lack of development of the echographic semiotics of acute appendicitis depending on morphological forms. According to A.S. Beilin [2], Chinese doctors obtain positive results from acupuncture in acute appendicitis. Surgery is performed in only 6.6% of cases. This indicates that by stimulating and correcting adaptive responses it is possible to significantly reduce the number of surgeries for appendicitis, but we have not found any indications for the use of acupuncture for appendicitis in the available literature. These circumstances prompted us to conduct this study. Objective of the study. The aim of this study was to reduce the number of unjustified appendectomies using ultrasound and acupuncture. Materials and methods of the study: The study is based on the analysis of the effectiveness of ultrasound and acupuncture in 250 patients admitted with suspected acute appendicitis. Of these, 130 (52%) patients underwent surgery. After appendectomy and morphological examination, catarrhal appendicitis was diagnosed in 62 (24.8%), phlegmonous appendicitis in 42 (16.8%), and gangrenous appendicitis in 26 (10.4%) patients. Appendiceal colic was diagnosed in 120 patients (48%) based on clinical, echographic, and acupuncture data, and they did not undergo surgery. Ultrasound was performed using an ALOKA SSC-370 diagnostic system with real-time linear and sector transducers. The ultrasound began using the generally accepted technique of applying graduated compression to the patient's anterior abdominal wall. This reduces the transducer-to-appendix distance, helps move gas-filled intestinal loops, and visualizes the appendix. Normally, the vermiform appendix does not exceed 0.8 cm in diameter, and when inflamed, it appears as an elongated, echo-negative structure with dense walls, with an internal lumen of 0.8-1.5 cm. In cross-section, the appendix had a characteristic "target" sign. In the case of local peritonitis, traces of free fluid are detected in the iliac fossa or pelvis. Regarding the acupuncture test for all patients admitted with a diagnosis of acute appendicitis, we used one of four auricular points: "Appendix 1," "Appendix 2," "Appendix 3," and "Appendix 4," in combination with the corporal point E-36 (zu-san-li) and the extra-meridian point BM-142 (lan-wei-xue, "appendix") using the "inhibitory stimulation" method. The needle is inserted with slow, rotating movements, gradually increasing amplitude and increasing stimulation intensity. The patient experiences mild local distension, heaviness, aching, numbness, and a gradually increasing current with a large irradiation zone. After the above sensations appear, the needle is left in the tissue for 15-30 minutes. The purpose of the acupuncture test is to relieve vascular congestion in the appendix, based on the concept of a relationship between pain and increased peripheral vascular tone, with acupuncture exerting an antispasmodic effect. Acupuncture efficacy was rated as "good" (+++) when abdominal pain and other negative sensations completely subsided during or immediately after the session. "Satisfactory" (++) indicated the same result being achieved within 2-3 hours, "questionable" (+) indicating a slight improvement associated with a decrease in pain intensity, but the pain does not completely resolve, and "negative" (-) indicating a complete lack of effect. We assessed acupuncture efficacy based on the morphological form of acute appendicitis, which helps select an appropriate treatment strategy. In cases of appendicular colic and catarrhal appendicitis, the patient's condition improves, pain subsides, and local symptoms become negative. If destructive changes in the appendix are present, the symptoms after the acupuncture test remain positive, which serves as a differential diagnosis between appendicular colic and destructive appendicitis. Results and discussion: The results of acupuncture indicate that, for appendicular colic, generally good and satisfactory results were achieved. Similar results were also achieved in 51.6% of cases of catarrhal appendicitis. However, these results were not sufficiently considered due to a lack of experience, and patients underwent surgery, which demonstrated the hasty decision made. In destructive forms of appendicitis, acupuncture generally failed to produce a positive effect. Analysis of the results of ultrasound examination (Table 1) shows that in case of appendicular colic, indirect echographic signs were detected only in 6 (5.0%) patients, in case of catarrhal form, direct signs were found in 7 (5.8%), indirect signs in 18 (29%), i.e. almost 1/3 of patients, whereas in destructive forms these indicators increase significantly in inverse proportion. Table 1 Frequency of echographic signs in various forms of acute appendicitis and appendicular colic. Echographic signs of Append. colic catarrhal appendicitis phlegmonous appendicitis gangrenous appendicitis Direct - target - - 29 69±7.1 22 - longitudinal structure - 7 5.8±2.8 6 14.3±5.4 4 15.4±7.0 Indirect - intestinal pneumatization 6 5.0±2.0 18 29±5.6 18 42.9±8.2 14 53.8±9.8 - - - 7 16.7±5.7 9 34.6±9.3 - free fluid - - 27 64.3±7.4 21 80.8±7.7 Total: 120 62 42 26 Free fluid in the right iliac fossa and cavity of the small pelvis was detected only in patients with acute phlegmonous (64.3%) and gangrenous (80.8%) appendicitis and indicated the development of local peritonitis. Thus, the use of acupuncture and ultrasound helps to differentiate appendicular colic and catarrhal appendicitis from its destructive forms, therefore, to outline the appropriate treatment tactics to avoid unnecessary appendectomies. References 1. Barayev T.M. On the problem of acute appendicitis.// Vestn. shir. - 1999. - No. 4. - P. 35-37. 2. Beilin P.S. Is appendectomy always beneficial? // Med. newspaper. - 1963. - No. 8. 3. Dzhumabayev E.S., Akhliddinov O.A. Acute catarrhal appendicitis: is appendectomy necessary?// Surgery. - 2004. - No. 2. - P. 69-72. 4. Dronov A.F., Kotlobovsky V.I., Poddubny I.V. Laparoscopic appendectomy in children: experience of 2300 operations.// Surgery. - 2000. - No. 6. - P. 30-36. 5. Lushnikov E.G. Surgeon's tactics for mild appendicular symptoms and "appendicular colic".// Sov. medicine. - 1958. - No. 11. - P. 44-49. 6. Sovtsov S.A. Acute appendicitis: controversial issues.// Surgery. - 2002. - No. 1. - P. 59-61. 7. Torgunakov A.P. What to do with simple (catarrhal) appendicitis?// Surgery. - 2005. - No. 7. - P. 60-62.