A study reveals that most patients who chose antibiotic treatment over immediate surgery for appendicitis encountered positive long-term results.
The findings provide valuable information about the possible advantages of non-surgical approaches to addressing this prevalent condition.
However, the research also unveiled that a subset of patients needed surgical intervention even after up to 20 years.
The study, which involved follow-up on 292 patients, drew from two randomised controlled trials conducted in the 1990s by the Swedish National Patient Registry.
In both tests, patients were divided into two groups: those who underwent the traditional surgical approach of appendectomy and those who were administered antibiotic treatment as an alternative for their appendicitis.
The primary focus of the study was to assess the rates of recurrent appendicitis that necessitated surgical intervention later down the line.
The findings painted a nuanced picture of outcomes.
Key takeaways from the study include:
Long-term success: Over 60% of patients in the non-operative group managed to avoid a recurrence of appendicitis and an appendectomy over circa 20 years.
Delayed surgical needs: Around 29% of patients from the non-operative group, who were initially discharged without surgery, eventually required appendectomies later in life.
Delayed antibiotic response: A subset of patients who initially received antibiotic treatment ended up needing surgery up to two decades later, suggesting the effectiveness of antibiotic treatment might wane over time.
Surgical clinic visits: Among those who didn’t undergo immediate surgery, approximately 9.5% sought care at surgical outpatient clinics due to abdominal pain. This contrasts with 0.01% of patients who underwent the conventional surgical route.
The study’s authors concluded that the findings suggest more than half of the patients treated non-operatively enjoyed sustained relief from appendicitis symptoms and could avoid surgery over about 20 years.
They highlighted no evidence of substantial long-term risks associated with non-operative management, except for the risk of appendicitis reoccurring.
The study was led by Simon Eaton, PhD, from the UCL Great Ormond Street Institute of Child Health in London.
Published online in JAMA Surgery, the research was made possible through funding from the NIHR Biomedical Research Centre at Great Ormond Street Hospital and the Swedish Research Council.
According to a paper published earlier this year in BMC Gastroenterology, appendicitis remains a significant public health challenge globally. Increasing awareness of appendicitis, its risk factors and the importance of early diagnosis and treatment could reduce its burden.
The authors concluded that ‘improving appendicitis health data in all regions and countries and monitoring the burden and treatment of appendicitis should be given more attention’.
