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Tuesday, September 25, 2018 – If you suffer from acute appendicitis, you could be treated successfully with antibiotics and never need an operation to remove your appendix, report Finnish researchers.
Most cases of appendicitis are not complicated, which simply means that the organ has not been broken, so that they can be treated with antibiotics. This is only when the appendix seems to be able to burst immediately as an operation is needed. And the difference is easily seen on a CT scan, said lead researcher Dr. Paulina Salminen, a surgeon at Turku University Hospital.
"There are no serious complications associated with antibiotic therapy, so it's a safe option," she said.
About 20 to 30% of patients with appendicitis have a perforated appendix that needs to be removed, but 70 to 80% of patients may require only antibiotics, added Salminen.
A perforation is a small tear in the appendix that lets its contents flow into the stomach. This can cause a potentially fatal blood infection.
In a trial comparing 273 patients who had an appendectomy with 257 treated with antibiotics, the researchers found that about 60% of people treated with antibiotics did not need to have their appendix removed in the five years following the treatment.
In total, 100 of the 257 patients treated with antibiotics had to undergo an appendectomy during the five years of the study, including 15 patients operated on during the initial hospitalization, the researchers found.
The report was published Sept. 25 in the Journal of the American Medical Association.
An American expert spoke of the advantages and disadvantages of antibiotics instead of surgery.
"I think the big problem is this: Can doctors and patients accept the fact that there could be nearly 40% chance of re-offending in five years?" said Dr. Robert Glatter, emergency physician at Lenox Hill Hospital in New York.
It might not be acceptable to many people, he said.
"It's a question of knowing what risk aversion you really want to be, given that once your appendix is removed with uncomplicated appendicitis, your risk of complications is quite minimal," said Glatter. .
Patients must understand that even though antibiotics can effectively treat acute appendicitis 60-70% of the time, treatment can also fail and require surgery, he said.
Although the attention and popularity of the antibiotic-only approach has been increasingly sought after, additional studies are needed in specific subgroups of patients at higher risk, including appendicolithes with calcified deposits. These patients were excluded from this latest study, noted Glatter.
In addition, the study focused only on open appendectomy and not the least invasive laparoscopic appendectomy. The laparoscopic approach is associated with shorter hospital stay and lower risk of complications than open surgery, explained Glatter.
Antibiotic therapy required three days of intravenous antibiotics administered at the hospital, as well as seven days of oral antibiotics. The stay in the hospital after laparoscopic surgery was only one day, he noted.
"The decision to introduce antibiotics only, as opposed to the continuation of an operative approach to treat acute appendicitis, should integrate the shared decision-making between physicians, patients and their families" said Glatter.
In fact, a recent study from the University of Dakota's Faculty of Medicine found that although appendicitis often resolves through the use of antibiotics, the vast majority of Americans would choose rather a surgery. According to the survey results, only about 1 in 10 adults reported that he would use antibiotics to alleviate an inflamed appendix.
More information
Visit the US National Institute of Diabetes and Digestive and Kidney Diseases to learn more about appendicitis.
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