When a patient presents at the hospital with appendicitis, the standard course of action is to remove the appendix in an emergency surgery. But as the Associated Press reports, a new study published in the Journal of the American Medical Association suggests that there may be an effective, but less invasive alternative to treating appendicitis: antibiotics.
Appendicitis is characterized by the inflammation of the appendix, a little sac that protrudes from the colon. The condition is likely caused by a blockage in the lining that results in an infection. Doctors act quickly to remove inflamed appendices because they are at risk of bursting, which can be life-threatening to the patient.
Advances in computerized tomography (CT) scans, however, have made it easier for doctors to determine whether an appendix is on the verge of rupturing. According to Nicholas Bakalar of The New York Times, recent research has indicated that antibiotics may be an appropriate treatment for uncomplicated acute appendicitis—or in cases where the appendix has not ruptured, the white blood count is low and there is no fecal blockage. But the long-term outcomes of forgoing surgery were not clear.
The new study, conducted by researchers in Finland, followed more than 250 adults for five years after they had been given antibiotics—three days of intravenous antibiotics in hospital, then seven days of pills at home—as treatment for appendicitis in a randomized trial. The team compared this group to another 270 patients who had undergone an appendectomy.
Out of the antibiotics patients, around 64 percent of the group did not require surgery within five years of being treated with antibiotics. One hundred eventually had an appendectomy; 70 of them within the first year after initial treatment. Most of the surgeries were required due to a recurrent case of appendicitis, but seven of the returning patients were revealed to not actually have the condition. Also significant is the fact that delaying the surgery did not seem to have any negative impact on the patients who eventually needed an appendectomy.
Those who received antibiotics took 11 fewer sick days, on average, than the surgery group. Only seven percent of the antibiotics group experienced complications post-treatment, compared to one in four surgery patients, who dealt with afflictions like hernias, abdominal pain and infections of the surgical incision.
Dr. Paulina Salminen, a surgeon at Turku University Hospital in Finland and the lead author of the study, tells the AP that antibiotics should consequently be seen as a “feasible, viable and a safe option” for treating uncomplicated appendicitis.
There are, however, benefits to simply going ahead with the standard treatment. As Edward H. Livingston, the deputy director of JAMA, notes in an editorial that accompanied the new study, appendectomies involve relatively few major complications and afford patients the peace of mind that an appendicitis attack will not recur. It is also important to note that the surgeries in the Finnish study had all been performed with conventional incisions; in the United States, according to the AP, less invasive “keyhole surgeries,” which are performed laparoscopically with small incisions, are more common for appendectomies.
And yet, Livingston writes, the new findings “dispel the notion that uncomplicated acute appendicitis is a surgical emergency.” Patients should be made aware of the possibility of eventually needing an appendectomy, but starting with non-surgical treatment in some cases, he says, is a “reasonable option.”