Since decades there is an ongoing discussion if appendectomy rates and their indication for surgery are too easily made. A randomized controlled trial (NCT01572558) from Sweden, UK and Canada is quite interesting.
Abstract
Objective: The aim of this study was to evaluate the feasibility and safety of nonoperative treatment of acute nonperforated appendicitis with antibiotics in children.
Methods: A pilot randomized controlled trial was performed comparing nonoperative treatment with antibiotics versus surgery for acute appendicitis in children. Patients with imaging-confirmed acute nonperforated appendicitis who would normally have had emergency appendectomy were randomized either to treatment with antibiotics or to surgery. Follow-up was for 1 year.
Results: Fifty patients were enrolled; 26 were randomized to surgery and 24 to nonoperative treatment with antibiotics. All children in the surgery group had histopathologically confirmed acute appendicitis, and there were no significant complications in this group. Two of 24 patients in the nonoperative treatment group had appendectomy within the time of primary antibiotic treatment and 1 patient after 9 months for recurrent acute appendicitis. Another 6 patients have had an appendectomy due to recurrent abdominal pain (n = 5) or parental wish (n = 1) during the follow-up period; none of these 6 patients had evidence of appendicitis on histopathological examination.
Conclusions: Twenty-two of 24 patients (92%) treated with antibiotics had initial resolution of symptoms. Of these 22, only 1 patient (5%) had recurrence of acute appendicitis during follow-up. Overall, 62% of patients have not had an appendectomy during the follow-up period. This pilot trial suggests that nonoperative treatment of acute appendicitis in children is feasible and safe and that further investigation of nonoperative treatment is warranted.
Svensson JF, Patkova B, Almström M, Naji H, Hall NJ, Eaton S, Pierro A, Wester T: Nonoperative Treatment With Antibiotics Versus Surgery for AcuteNonperforated Appendicitis in Children: A Pilot Randomized Controlled Trial. Ann Surg. 2014 Jul 28
http://journals.lww.com/annalsofsurgery/Fulltext/2015/01000/Nonoperative_Treatment_With_Antibiotics_Versus.12.aspx
Thanks @Mesut.
do you hereby propose that the quality of the randomized trial of Svensson et al. has a comparable quality as the funny parachute article in BMJ some years ago?
Why not?!? We treat diverticulitis even with perforation with laparoscopic lavage and antibiotics. So why not try to treat appendicitis with antibiotics.
I do not know what happens. Bu I posted as answer hat I did not delete any comment/answer and this is deleted,too. I wonder who has done it!???!
I think this is an interesting article, and it certainly stimulates thought. However before changing practice I would like to see a full RCT with a much longer follow-up period of at least five years.
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