Surgery for appendicitis is common today. It is very likely that if you have not had the operation, in which the appendix is removed, you know a person who does. Almost 300,000 appendectomies are performed in the United States each year alone.
However, a new study published this week in the scientific journal JAMA suggests that these operations are not necessary and that antibiotics could be a viable and effective treatment for appendicitis. The idea of antibiotic treatment came after it was known that divers treated appendicitis with them during the Cold War, since they could not get on their submarines during that time, according to surgeon F. Thurston Drake of the Boston Medical Center .
“Knowledge that this was successful sort of ‘re-surfaced’ in the last 15-20 years, prompting researchers to study whether antibiotics was a viable treatment rather than just a delaying tactic until appendectomy could be performed,” said Drake.
Appendectomy is the preferred treatment for appendicitis, mainly because it seems that humans do not need it. Some doctors, like pediatric surgeon Janice Taylor, explain it this way: “If it’s out, it can’t hurt you. It’s a low-risk, pretty routine operation. There are millions of people walking around without appendixes, and they do just fine.”
The JAMA study was conducted for five years and focused on the observation of 530 men and women between 18 and 60 years old. Randomly, individuals were treated for appendicitis without complications with an appendectomy or with antibiotics after a CT scan.
Treatment with antibiotics consisted of an intravenous dose of Ertapenem for three days and seven days of oral antibiotics. On the other hand, the surgeries were conventional open surgeries.
Of those who were treated with antibiotics, 61% did not need surgery during the five years of observation. However, 39% of patients treated with antibiotics suffered a recurrence and needed surgery in the future. This delay did not result in complications for the patients. 27.3% of patients returned and were operated on within one year after antibiotic treatment.
Although these numbers are not great, they are important because they mean that patients have more options. According to Popular Science , people with appendicitis who are older, are very sick or have other reservations about having surgery may want to be treated with antibiotics. Everything depends on the risk that the individual wants to assume.
In some cases, you may have to assume the risk of having appendicitis again in the future. But there is also the risk of complications associated with rapid surgery.
The new finding has also led to new questions and concerns. Some doctors worry about what people will think if they do not remove the appendix. They will always be left with the doubt about whether the pain they feel is appendicitis or simply a bad reaction to food or stiffness.
Others, like Drake, fear that doctors could treat patients with antibiotics in situations in which it is not clear if the patient has appendicitis, causing problems such as antibiotic-resistant bacteria.
In the end, Drake, who was not involved in the investigation, says that both treatments are effective in his opinion. But it remains to be determined what type of patient is ideal for each treatment.
“As surgeons, we are moving more towards patient-centered decision making, especially when we have two or more good options,” says Drake. “Finally, we will provide the best care when we can determine the advantages and disadvantages of each treatment, adjusted to each patient, and then make a joint decision about which treatment is best for him or her.”
