Appendicitis, or inflammation of the appendix, occurs in 250,000 people each year in the US. The standard treatment is surgery to remove the appendix. A new study in the Journal of the American Medical Association suggests that in some patients with appendicitis may not need surgery.
The appendix is located in the right lower abdomen and serves no useful function for the body. When it becomes inflamed, it causes pain in that area, along with fevers, nausea, or vomiting.
A classic history for appendicitis is pain that initially occurs around the belly button before moving to the right lower abdomen. The diagnosis is often confirmed by a CT scan showing inflammation around the appendix. For decades, the standard treatment for appendicitis is urgent removal of the appendix. Recently, there has been growing interest in using antibiotics, rather than surgery, to treat appendicitis.
Dr. Paulina Salminen, a surgeon at Turku University in Finland and colleagues, studied 530 patients between age 18 and 60 with uncomplicated appendicitis. The researchers randomly divided the patients into two approximately even groups. One group was treated with surgery while the other group was treated with a strong antibiotic. They followed patients for up to one year after the initial episode of appendicitis.
They found that the surgery group had a 99 percent success rate at removing the appendix. However, initial surgery was also associated with a 20 percent complication rate, which included surgical infections, hernias and persistent pain.
In the antibiotic group, 70 percent of patients did well with antibiotics and 30 percent of patients needed to have surgery within the next year due to repeat appendicitis. Patients in the antibiotic group who had surgery later had a lower complication rate compared to patients who had surgery on the first presentation of appendicitis. Dr. Salminen’s study shows that although surgery for appendicitis is the tried and tested treatment, more than two in three patients do well without surgery.
This is important for patients who are hesitant to have surgery or who live in areas where a surgeon is not available. Importantly, these results are only true for uncomplicated appendicitis. A patient with appendicitis who is sicker will need urgent evaluation by a surgeon. Overall, surgery remains the standard of care, Dr. Salminen’s paper shows a wait-and-see approach with antibiotics may be reasonable in some patients with uncomplicated appendicitis.