April 10, 2012
Alternative to Surgery for Appendicitis
(Ivanhoe Newswire) -- There's now a safe and viable alternative to surgery for patients suffering from appendicitis.
Surgery to remove an inflamed appendix (appendectomy) has been the mainstay of treatment for acute appendicitis since 1889 and the general assumption is that, without surgery, the risk of complications, such as perforation or infection, is high.
Researchers at the Nottingham Digestive Diseaeses Centre NIHR Biomedical Research Unit, in Nottingham, UK, teamed up to analyze the results of four randomized controlled trials involving 900 adult patients diagnosed with uncomplicated acute appendicitis. A total of 470 patients received antibiotics and 430 underwent surgery.
Antibiotic therapy was associated with a 63% success rate at one year and a 31% relative reduction in complications compared with surgery.
Even after excluding patients from one study who crossed over from the antibiotic group to the surgery group, a significant (39%) reduction in complications with antibiotic therapy compared with surgery remained.
Of 68 patients treated with antibiotics who were readmitted with recurrence of symptoms, four had normal appendix and 13 had complicated appendicitis. Three patients were treated successfully with another course of antibiotics.
The authors argue that the role of antibiotics in acute uncomplicated appendicitis "has been overlooked based mainly on tradition rather than evidence" and they suggest that a careful 'wait, watch and treat' policy may be adopted in patients considered to have uncomplicated appendicitis or in whom the diagnosis is uncertain.
However, they stress that for those with clear signs of perforation or peritonitis (inflammation of the abdominal wall) early appendectomy still remains the 'gold standard.'
They conclude that antibiotic therapy "is a safe initial therapy for patients with uncomplicated acute appendicitis" and that it "merits consideration as a primary treatment option for early uncomplicated appendicitis."
SOURCE: BMJ-British Medical Journal, April 2012