Treatment of appendicitis – Without Surgery in 2022

treatment of appendicitis, introduction, table of content, Importance, objective, design, setting, participation, Results, Conclusion

Introduction

During the cold war, when a sailor was diagnosed with appendicitis, they were given antibiotics as there was no option for surgery under the sea.

Instead, the sailor was usually given a non-surgical treatment antibiotic. Once the submarine is able to resurface, the sailor received surgery if needed. In most cases, the appendicitis result without surgery.

Despite this, appendectomy continued to be the treatment of choice for all cases of appendicitis.

Importance

The clinical trials now show that for cases of uncomplicated acute appendicitis diagnosed by abdominal CT scan, antibiotics are a safe alternative to appendectomy as a first-line approach.

However, prior studies had focused on short-term outcomes 30 days to a year.

Objective

In the current issue of JAMA, we report results from a five-year follow-up patients randomised to receive antibiotic therapy and a trial comparing antibiotics to surgery in patients with acute uncomplicated appendicitis.

Design, Setting, and Participation

The original trial was designed to test the non-inferiority of antibiotics compared to surgical management.

It randomized 530 patients in Finland between the ages of 18- 60, with CT confirmed uncomplicated acute appendicitis to appendectomy or antibiotic therapy comprising Ivy Ertapenem for 3 days, followed by seven days of oral Levofloxacin and metronidazole.

Interventions

Main Outcomes and Measures

The one-year findings, reported in JAMA in 2015, failed to show the antibiotics were not inferior to surgery. However, 3/4 of the patients treated with antibiotics didn’t require surgery, and none of the patients who underwent surgery had complications related to waiting to perform an appendectomy.

Results

Now let’s review the five-year results, which are new this week. The main outcome of the five-year study was to establish the recurrence rate of appendicitis treated with antibiotics.

The authors report that the cumulative incidents are recorded appendicitis in the patients initially treated with antibiotics was 27% at one year and 34% in two years. 35% in three years, 37% in four years, and 39% in five years.

Seventy patients initially treated with antibiotics underwent an appendectomy in the first year of the study and 30 in years 1 to 5. Of these 30 patients, only two had complicated appendicitis.

Conclusion and Relevance

 The authors conclude that long-term follow-up of patients with CT-diagnosed uncomplicated appendicitis suggests that initial treatment with antibiotics is a safe alternative to appendectomy.