Friday, February 10, 2017 by Vicki Batts
When most people think of appendicitis, they also think of appendectomy — or the removal of the appendix. For years, removing the tiny organ has been something of a standard procedure in the treatment of appendicitis. But new research shows that surgery is often not necessary.
Appendicitis is characterized by abdominal pain, primarily on the right side. The appendix has become inflamed, generally due to a blockage or infection. Some other symptoms include abdominal swelling, vomiting, nausea, and a low fever, but these are not all always present. While anyone can develop the condition, it occurs most often in people between the ages of 10 and 30 years of age. Appendicitis is also the most common cause of emergency surgery in children.
MedlinePlus.gov notes that “surgery is almost always required.” And yet, research from Southampton’s university hospitals have found that this is simply not the case, at least for children with a certain type of appendicitis.
The team of researchers led by Nigel Hall, a consultant pediatric surgeon at Southampton Children’s Hospital, found that after initial treatment with antibiotics, only a mere 12 percent of pediatric patients with an appendix mass developed recurrent appendicitis and required a surgical intervention. [Related: Learn why it is a good idea to keep your appendix, if you can.]
Approximately one-in-ten children will develop an appendix mass, which is a specific type of acute appendicitis. Conventionally, this condition is treated without an initial operation and is instead treated with a round of antibiotics. However, surgery to remove the appendix, known an an “interval appendectomy,” is often done to prevent recurrence. [RELATED: Keep up with the latest medical headlines at Medicine.news]
Hall explained that most pediatric surgeons treat children who present acutely with an appendix mass without an operation, but that more than two-thirds of surgeons were routinely recommending interval appendectomies. Hall also notes that the “justiﬁcation for this surgical intervention has never been prospectively challenged.”
So, Hall and his team decided that they would be the ones to challenge the norm, and they did so quite successfully.
“A systematic review of retrospective studies suggested the incidence of recurrent appendicitis was approximately 20%, but we have shown that figure is much lower. This calls into question the justification for surgery as standard practice,” Hall stated.
The research team collected data from 102 children from 17 specialist centers across the United Kingdom, and one center each in Sweden and New Zealand. All of the patients were between the ages of 3 and 17. Between the years of 2011 and 2104, 50 patients were assigned to have an interval appendectomy, while the remaining 52 were assigned to active observation without surgery. [RELATED: Learn more about the latest research at Scientific.news]
The team found that 75 percent of the children avoided having the appendectomy surgery after being treated for appendicitis without surgery. Their findings also noted that 6 percent of patients who underwent surgery experienced severe complications.
Hall believes that adopting a “wait and see” approach for interval appendectomy is the way to go, and its easy to see why. It’s less costly and also generally less disruptive and painful for the child, especially given the fact that in many cases, there is no need for surgery at all.
Other research has also shown that appendectomy surgery may not always be necessary. In 2014, Fox News reported on a study led by Dr. Peter Minneci, from Nationwide Children’s Hospital in Columbus, Ohio.
Dr. Minneci and his colleages compiled data on 77 children and teens who presented with uncomplicated acute appendicitis. Of those kids, 47 opted to just have the surgery, while 30 decided to try antibiotics.
A staggering 97 percent of the children who took the antibiotics never needed any further treatment; only 3 patients went on to need surgery at a later date.
“In this group of patients with uncomplicated appendicitis – in the people we studied, non-operative management with antibiotics alone appears to be a reasonable alternative,” Dr. Minneci said.
Similar findings were also reported on by CNN in 2015; a Finnish study found that 73 percent of people who took antibiotics did not end up needing surgery for their uncomplicated appendicitis.