Surgery May Not be Required for Appendicitis
TURKU, Finland, June 17 (UPI) — Many cases of uncomplicated appendicitis could be treated with antibiotics in the future, a stark change after 100 years of the condition’s primary treatment being to surgically remove the organ.
A study in Finland found that 73 percent of appendicitis patients treated with antibiotics did not need to have their appendix removed within a year.
“Our hypothesis was that most of the patients with uncomplicated appendicitis may be treated with antibiotics rather than surgery,” said Dr. Paulina Salminen, adjunct professor and head physician of the Emergency Surgery Unit at Turku University Hospital, in a press release. “In this way, Unnecessary operations and the morbidity associated with surgery could be avoided. At the same time, substantial savings would be made.”
Roughly 80 percent of appendicitis patients have an uncomplicated case that could potentially be treated without surgery, as compared to the other 20 percent who generally require immediate surgery because their appendix has ruptured or is in danger of doing so.
Researchers assembled two groups of patients for the study, 273 who underwent surgery and 257 who received antibiotic treatments.
All but one of the surgical group patients underwent successful surgery while 72.7 percent of the antibiotic group did not require surgery. Of 27.3 percent of the antibiotic group who underwent surgery within a year, 58 of them had uncomplicated appendicitis, 7 had acute appendicitis and five did not have appendicitis but had an appendectomy because doctors suspected it was going to reoccur.
“I think we need to determine who are really candidates for this type of nonoperative therapy,” Dr. Curtis Wray, an associate professor of surgery at the University of Texas Health Science Center, told CNN. He said it’s possible the high failure rate could be due to the antibiotics not clearing up the obstruction in the appendix that caused the organ’s inflammation, or their appendicitis could have been more advanced.
Appendicitis is caused by a bacterial infection in the appendix that causes inflammation and obstruction, with severe cases causing the appendix to burst and send bacteria into the abdominal cavity.
Appendectomies have been the automatic medical response to appendicitis for more than 130 years because it prevents the chances of the organ bursting and causing more problems. This has held true even after the discovery of antibiotics in the 1950s and their successful use in some appendicitis cases.
“The reason we take the appendix out and do it as an emergency is the belief, dating back to 1886, that the appendix will eventually become gangrenous and cause a pelvic abscess,” Dr. Edward Livingston, who wrote an editorial supporting the use of antibiotics which was published with the study, told the New York Times.
The study is published in the Journal of the American Medical Association.
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