Academic Journal
Main Category: GastroIntestinal / Gastroenterology
Also Included In: Public Health
Article Date: 06 Apr 2012 - 13:00 PDT
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Surgery need not be the first line of treatment for acute uncomplicated appendicitis, researchers from Nottingham Digestive Diseases Centre NIHR Biomedical Research Unit, England, reported in the BMJ (British Medical Journal). Often, the use of antibiotics may be a safe and viable alternative, the authors explained.
As background information, the researchers explained that since 1889, appendicectomy - surgically removing the inflamed appendix - has been the standard treatment for acute appendicitis. Doctors have assumed that the risk of complications, such as infection or perforation, are too high without surgery.
According to recent studies, however, antibiotic therapy results in fewer problems and complications than surgery for patients with uncomplicated appendicitis. However, the studies have not had compelling enough evidence either way, the researchers wrote.
The authors set out to determine how safe and effective antibiotic therapy might be, compared to surgery, as an initial treatment for uncomplicated acute appendicitis.
They gathered data from four randomized, controlled human studies which included 900 adults; they had all been diagnosed with uncomplicated acute appendicitis. 470 of them were randomly selected to receive antibiotics, while 430 had their appendixes removed surgically.
In order to minimize bias, study design and quality variations were taken into account.
Antibiotic therapy was linked to a 63% success rate at twelve months, and a 31% relative reduction in complications.
The authors found that there was a significant reduction in complications (39%), compared to surgery, after excluding those in one study who crossed over from antibiotics to surgery.
68 patients in the antibiotics groups were readmitted to hospital with recurring symptoms, of which 4 had normal appendix and 13 complicated appendicitis. Three of them were successfully treated with further antibiotic therapy.
Lengths of hospital stays, and appendicitis complications risk were similar in both the antibiotic and surgery groups (when all studies were taken into account).
The researchers explained:
"(Antibiotic therapy usage in acute uncomplicated appendicitis) has been overlooked based mainly on tradition rather than evidence.."
Patients with uncomplicated appendicitis, plus those whose diagnosis is not certain, should perhaps receive a "wait, watch and treat" approach, the authors suggest.
Prompt surgery should still be the "gold standard" for those with evident signs of perforation or inflammation of the abdominal wall (peritonitis), they emphasized.
The investigators concluded:
"(antibiotic therapy) is a safe initial therapy for patients with uncomplicated acute appendicitis. It merits consideration as a primary treatment option for early uncomplicated appendicitis."
Accompanying Editorial in the same journal
Dr Olaf Bakker, who works at the Department of Surgery at the University Medical Center, Utrecht, the Netherlands, says that a conservative approach to appendicitis has "major certain disadvantages". During the first 12 months, the recurrence rate is up to 20%.Dr. Bakker wrote:
"(until we have more convincing and longer term results) appendectomy for uncomplicated appendicitis will probably continue."
Written by Christian Nordqvist
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