A commonly known treatment method of acute appendicitis is an appendectomy. It is more frequently performed in laparoscopic way, what decreases the risk of wound infection, is less painful, shortens time of hospitalization and makes the patients return to their previous activity faster.
The Finnish researchers wanted to check if it is possible to treat acute uncomplicated appendicitis, confirmed with CT, only with adequate antibiotics. Research involved 530 patients, aged 18-60, who were diagnosed with acute uncomplicated appendicitis during computer tomography between 2009-2013. The patients were intentionally divided into two groups. The study group involved 257 patients who received antibiotics therapy. The control group consisted of 273 people who underwent appendectomy. They have received only prophylactic preoperative dose of 500 mg metronidazole and 1,5 g cefuroxime intravenously. In 15 of the patients laparoscopic appendectomy was performed. The patients were followed-up for one year. The study group was treated with ertapenem for three days 1g/day intravenously and for the next 7 days orally with metronidazole 3×500 mg and levofloxacine 1x500mg.
70 patients from the study group had to undergo appendectomy within one year since the first diagnosis. 186 people did not need any operation. 7 (10%) of the 70 operated patients had complicated acute appendicitis, and 5 (7,1%) did not have acute appendicitis but appendectomy was done because of surmised recurring appendicitis. None of the patients had severe complications like intra-abdominal abscess. The patients were followed-up on 7 days, 3 months and one year after the first diagnosis.
In 2 patients of the control group appendicitis was not histopathologically confirmed. Four patients had histopathologically confirmed cancer process of appendix (3 neuroendocrinological tumors, one adenocarcinoma). 15 patients from the study group underwent appendectomy within first hospitalization, 7 of them had acute complicated appendicitis and in 5 appendix was perforated. 55 patients from the study group were hospitalized because of symptoms characteristic for acute appendicitis within first year and finally they underwent appendectomy. 50 of them had histopathologically confirmed appendicitis.
The researchers wanted to show that patients may profit from conservative method of appendicitis treatment. Unfortunately, it turned out that a lot of patients required surgery. Moreover, the patients under antibiotic therapy were hospitalized longer (median 3 days) than those who underwent appendectomy (median between 2-3 days). However, the researches proved that computer tomography helps in adequate diagnosis of acute appendicitis whether it is complicated or not. Regardless of the usage of antibiotics with so broad spectrum, like ertapenem, in treatment of appendicitis, it does not seem reasonable nowadays with a lot of multidrug resistant bacteria. Although most of the patients from study group did not require appendectomy within the first year, 27% of them underwent surgery what seems to be quite significant number. Moreover, 4 of the primary operated patients were diagnosed with cancer. It should not be forgotten because if they were treated only with antibiotics, it would delay the right diagnosis and introduction of appropriate treatment. That is why appendectomy seems to be the best treatment for acute appendicitis so far.
Written by: Magdalena Chorążka
Source:
1. P. Salminien et all, Antibiotic Therapy Vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis, , JAMA, June 16,2015, Volume 313, Number 23.
2. Kim K, Kim YH, Kim SY, et al. Low-dose abdominal CT for evaluating suspected appendicitis. N Engl J Med. 2012;366(17):1596-1605
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