Your Health Checkup: Acute Appendicitis May No Longer Need Surgery

You may not need to go under the knife for certain cases of appendicitis — antibiotics alone may be just as effective.

Woman holder her right lower side, signifying pain from her appendix.
staras / Shutterstock

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“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

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In my memoir, Damn the Naysayers, I describe an event during which my wife had an episode of acute appendicitis that almost killed her. I returned home from a business trip in time to make the diagnosis, bring her to the hospital to have it verified by a cat scan, and then have her whisked to surgery with subsequent complete recovery. That scenario may soon be relegated to the history of medicine, replaced by antibiotics.

In 2015, investigators compared surgery versus antibiotics in treating uncomplicated appendicitis in about 500 patients. They found that nonoperative management had a one-year success rate of 73 percent with much fewer treatment-associated complications, and sick leave of a week compared to almost three weeks for operated patients. Long term follow up at seven years showed no difference in quality of life between groups.

This study was the first to show that patients with uncomplicated appendicitis could be treated successfully with antibiotics alone without increasing the risk of complications.

Two subsequent studies, one with more than 1,000 children treated with antibiotics versus laparoscopic surgery, and the other a randomized trial in about 1,500 adults found similar results, confirming the safety and effectiveness of nonoperative management of uncomplicated acute appendicitis.

The most recent trial, APPAC II, found a 70 percent treatment success rate with oral antibiotics at one year versus 74 percent success with intravenous followed by oral antibiotics. Future studies will help establish the most effective antibiotic regimen.

It’s clear that management of uncomplicated acute appendicitis may change safely from early surgery to outpatient oral antibiotic treatment, at least initially. A similar evolution occurred for the management of acute diverticulitis. Patients should discuss these choices with their caregiver. Such an option for outpatient treatment for acute appendicitis may be particularly beneficial during the present COVID-19 pandemic.

Medicine is constantly evolving to meet societal needs, which change as new challenges arise. Major recent advances include new approaches to lipid management, heart failure, coronary disease, and diabetes, topics for future columns.

Featured image: staras / Shutterstock

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