For something thought to be largely extraneous, the appendix can be a real pain. Hundreds of thousands of people in the U.S. have appendectomies each year, often for an appendix that is swollen rather than ruptured. But a new study suggests that many of those surgeries might often be as unnecessary as the organ they’re removing.
For early uncomplicated appendicitis in which the appendix is swollen but not ruptured, as is true in some 80 percent of cases, simple antibiotic treatment seems to work just fine, according to a new meta-analysis published online April 5 in BMJ. The data also revealed that antibiotic treatment reduces the rate of complications, because it, er, cuts down on surgery, which has been the primary treatment since the 1800s.
After analyzing four randomized controlled trials with a total of 900 patients with uncomplicated acute appendicitis, the researchers found that antibiotic treatment alone succeeded in 63 percent of cases and did not increase the rate of appendix rupturing.
Doctors often combine antibiotic therapy with surgery when a patient presents with appendicitis. But they have tended to rely on surgery “mainly on the basis of tradition rather than evidence” the authors noted. After all, taking out the organ eliminates the problem.
But now that we have the technology to look inside before we cut—via CT or ultrasound—doctors can pick out the few patients who have appendicitis that requires surgery instead of antibiotics alone. For the rest of patients, however, they can give them antibiotics and see if that clears up the inflammation. Although antibiotics (sans surgery) reduced the rate of complications, it didn’t seem to reduce hospital stay length.
Not everyone is convinced that antibiotics will supplant surgery for simple appendicitis just yet. The antibiotic-only approach has “major certain disadvantages,” Olaf Bakker, of the University Medical Center Utrecht in the Netherlands, noted in an accompanying essay in BMJ. In the first year after first being diagnosed with appendicitis, for example, as many as one out of five people will suffer symptoms again.
So until those stats improve, Bakker noted, “appendectomy for uncomplicated appendicitis will probably continue.”
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