Two-thirds of appendicitis operations are performed unnecessarily. Most inflammations do not require a surgeon’s intervention, but only a course of antibiotics, scientists say.
Medical dogma and 130 years of tradition have resulted in doctors often mistakenly believing that surgery is the only effective solution for appendicitis, according to a report published in the British Medical Journal. According to researchers from the NIHR Biomedical Research Unit at the Nottingham Digestive Diseases Center, there is overwhelming evidence that treating “uncomplicated” appendicitis with antibiotics is far more beneficial to patients than surgery.
Uncomplicated appendicitis, i.e. those that do not cause other problems, such as periappendicular infiltration or acute infection, account for about 80% of the total. cases. The remaining ones are complicated inflammations, the treatment of which requires surgical intervention.
Researchers checked how patients with uncomplicated appendicitis would respond to antibiotic treatment. Both approaches – antibiotic treatment and appendectomy (ridge removal surgery) – were studied in four trials involving approximately 900 patients. Volunteers were randomly assigned to one of two groups.
It turned out that within 12 months of the end of the treatment, 80 percent. people treated with antibiotics did not experience further attacks. This means that about 2/3 (63%) of the appendectomy may be considered unnecessary.
According to scientists, appendectomy has been considered a “basic” solution since 1889, when the procedure was first performed, while antibiotic treatment is definitely “disregarded”. “The disrespectful attitude to antibiotics in the treatment of acute uncomplicated appendicitis may be a tradition,” the authors write in their report.
Their observations show that routine referral of patients for appendectomy is based on the dogma that “appendicitis is a progressive disease – the mild form progresses to complications such as gangrene, periappendicular infiltrate or peritonitis – therefore postponing surgery increases the risk of complications.”
“In the case of early-stage uncomplicated appendicitis, pre-treatment with antibiotics is worth considering as the main treatment option,” they conclude.
‘If a doctor suspects uncomplicated appendicitis, nothing prevents you from starting antibiotics and seeing the patient’s response,’ says Professor Dileep Lobo, one of the research team members. – There’s a good chance it’ll be enough.
You can always refer a patient to surgery if it turns out that the antibiotics have not helped, he adds.
Approximately 20 percent of the appendicitis relapsed within a year. patients. This means that “only one in five patients develops complicated inflammation” requiring surgery.
Dr. Olaf Bakker of the Department of Surgery at the University Medical Center in Utrecht, however, believes that treating inflammation with antibiotics has a “serious downside”. In his opinion, a relapse of the disease within a year in every fifth patient is a very high rate.
Until more convincing results from longer-term studies become available, “appendectomy will be used for uncomplicated appendicitis,” says Bakker. Approximately 47 people are moving in Great Britain. appendectomy annually.
Tekst: Stephen Adams
Also read: Burning appendix