[ad_1]
Nearly one in 20 Americans will have appendicitis during their lifetime, which will result in 300,000 appendectomies each year. The vast majority of these 20 people go under the knife, have their appendix removed, leave the hospital after a day or two or recover and continue their lives. But what if you could correct your appendix problems without deciding anything? A study published Tuesday at JAMA suggests that antibiotics may be a viable and effective alternative to most appendectomies, raising the hope of those who would prefer non-surgical treatment to the extremely common disease.
The majority of cases of acute appendicitis are not complicated by larger problems, such as organ rupture or signs of tumor. "These patients can be evaluated by antibiotic therapy," says Paulina Salminen, a surgeon based at the University of Turku in Finland and lead author of the new study. "It takes a while to create a big change in the mentality of the patients, the doctors and the surgeons, but it has already started with the promising results. This could have a major impact on current surgical practices. "
There is a good reason why appendectomy is the treatment of choice for acute appendicitis for over a century: "You do not need it," says Janice Taylor, pediatrician at the University of Florida. "If it is not the case, it can not hurt you. It is a low risk and quite common operation. There are millions of people walking around without appendages, and they are doing very well.
But any invasive surgery, even though it is apparently as common as an appendectomy, carries risks, especially for patients in poor health or at risk of developing complications. Anesthesia sometimes creates unforeseen problems. There are also the practical hassles of surgery, such as financial impacts and absences from work.
In addition, says Taylor, we are beginning to err on the side of caution. Although we do not really know the purpose of the appendix – and to live without one does not cause any obvious detrimental effect – it is possible that the organ plays an immunological or physiological role. If our research on the gut microbiome has taught us anything, minor changes in our health might have bigger ramifications.
"We are surgeons, we love to operate, but we do not suggest surgery unless we really need it," says Taylor. And as for the appendix, apparently, this is not always the case.
According to F. Thurston Drake, Boston Medical Center-based surgeon, antibiotic therapy for the disease "stems from our knowledge that submariners treated appendicitis with antibiotics because they could not cover the surface during the cold War". "Knowing that it was somehow" surfacing "over the last 15 to 20 years has prompted researchers to consider whether antibiotics are a viable treatment rather than just a delaying tactic. that an appendectomy can be performed.
the JAMA The study looked at five-year observation of 530 men and women aged 18 to 60, randomized for appendectomy or antibiotic therapy in response to a diagnosis of uncomplicated acute appendicitis after a CT scan . Antibiotic therapy consisted of an intravenous dose of ertapenem (commonly used for serious bacterial infections) for three days, followed by seven days of oral antibiotics. All appendectomies were open conventional surgeries.
Nearly 61% of antibiotic-treated patients did not require surgery during these five years of observation. And even though about 39% of the patients suffered from a recurrence and required surgery later, this delay did not result in any increased or severe complication.
Let's be clear: these numbers are good, but not excellent. And the size of the sample of the study could certainly be larger. If you assume that the real world results will follow these numbers, four in ten people treated with antibiotics will have to be operated within five years, and 27.3% of them will be back in the year .
In contrast, one in four patients who had surgery had postoperative complications, such as abdominal pain or infections around the skin tissue. And the treatment costs for operated patients were about 60% higher than those for antibiotic patients.
If you are elderly, seriously ill or have other concerns, these numbers may be convincing enough for you to take antibiotics. For others, surgery could always be the solution. Things really depend on the type of risk that someone is willing to accept, that it's about the risk of relapse of appendicitis a few months or years later or the risk of complications from An immediate surgery.
Taylor also points out that the study treatment of patients with three days of intravenous antibiotics followed by seven days of oral antibiotics seems relatively arbitrary. "It's one of those choices, of course, that makes sense," she says. The results can therefore vary in both directions, if doctors change the diet.
As long as the appendix remains in the body, the risk of recurrence also remains. Taylor imagines that some might choose to completely dismiss the organ rather than deal with perpetual anxiety. "Every time you feel pain in the lower right quadrant," she says, "you're going to ask, is this my appendix? Is it just a pulled muscle? Am I having a bad mexican for lunch? Where does it come from? And then, this person will probably have to go to the emergency room or receive urgent care every time for imaging and blood tests that she may not need.
Drake also worries that providers may treat patients with antibiotics in situations where the diagnosis of appendicitis is less clear, exacerbating the problems associated with the inappropriate use of antibiotics , as the emergence of a superbug.
But none of these problems should detract from the encouragement to see antibiotic therapy emerge as an alternative for those who do not wish to literally lose a body part, and for those who want more agency deal with their decisions regarding Health care. "In my opinion, both treatments are effective," says Drake. "But we have not yet identified for whom each treatment is optimal. As surgeons, we are moving more towards patient-centric decision-making, especially when we have two or more good options. Ultimately, we will provide the best care when we can describe the advantages and disadvantages of each treatment, tailored to each patient, and then make a joint decision about which treatment is best for them.
Salminen and her team, already in the midst of two related studies, hope to deepen how this treatment method can be optimized for patients and their preferences.
"It basically comes down to the expectations of the patients and knowing what you're going for," says Taylor. "Antibiotics are a completely viable and appropriate option for the right patient."
[ad_2]
Source link
