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Just when you thought that there are some medical treatments which will never change, along comes some new research which blows the status quo  away.

Appendectomy or removal of the appendix has, for over hundred years, been considered the gold standard and in fact the only treatment for acute appendicitis. A recently published study provides evidence that there might be another way. Researchers divided patients with early acute appendicitis into two groups: One group underwent the usual treatment-that is surgical removal of the appendix. The other group were treated with antibiotics only.

Guess what? Those patients who were treated only with antibiotics not only did not develop peritonitis from rupture of the appendix, they also were about 30% less likely to suffer complications. Those who had the surgery had more complications as opening up the belly does result in higher risks of infection, scar tissue and pain than just antibiotic treatment.

This result goes against a long held medical dogma: Appendicitis can only be treated with appendectomy. Antibiotics are given but never without the surgery. If some patients truly can be managed without the surgery, this would not only reduce complications, it also would  save beaucoup dollars.

Still, before mainstream medicine can or should change its course, several caveats are in order. For one, this is a single study and would need to be repeated. Patients need to be carefully screened, as this surgery free course, requires that there be no evidence of rupture of the appendix or abscess formation. Thus, all patients would need to have a CT scan. CTs do expose patients to quite a bit of radiation. In fact, many patients for this reason are taken to surgery based on ultrasound results alone. (Ultrasound has no ionizing radiation).

Another problem is that with this study, about 20% of the patients given antibiotics alone required appendix removal within one year. 20%  is a lot of  people who would need a second CT scan and hospitalization.

For the present, this study will be looked at very carefully and if the results can be reproduced there could in the future be an alternative to an appendectomy, at least for some patients. Perhaps, patients might be offered a choice of immediate surgery or antibiotics with a wait and see approach.

It just goes to show you that, in medicine as in life, there are indeed no sacred cows.

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Comments

5 Comments

  1. John

    Last night I had a CT-scan and it showed I had an Acute Appendicitis. However, it did not show that it was leaking. This took a camera in my belly button. This really saved my life as I sincerely believe I’d be dead with just pill treatment while poison is leaking all over my organs. Antibiotics are not always effective for several reasons. Why take a chance that it will burst when the procedure is simple and so common 1 in 15 get one so while I appreciate looking to create the new wheel I think its more important to work with better techniques and aftercare. Its clear this is a very rough study and is inconclusive (if 20% have it done 1 year later what is the percent 2.3.6 years later??) Just sayin’… I write this from my hospital bed at Washington Hospital in Fremont, CA where I have been well cared for and had the coolest surgen ever. Better safe than sorry. Going through the pain twice would suck. Plus, the doc will look around for anything that could be wrong which requires being open.

    August 17th, 2012 10:52 pm

  2. Vaseffa Fennick

    Hey, came across your article because recently I had an appendectomy. 5 days post op I continually get incredible heart burn, even from water and when I eat I almost instantly feel full. Any thoughts

    October 10th, 2013 9:03 pm

  3. ERDoctor

    You should see your surgeon, who can determine whether a postoperative obstruction or other complication is present. If the pain becomes more severe or you have fever, you should go to the emergency room. I hope this helps.
    Sincerely,

    Rick Tietz

    October 12th, 2013 11:18 am

  4. Stephen

    I myself have personally recovered from acute appendicitis without surgery twice. Once was with antibiotics, because I steadfastly refused to give permission for the emergency surgery that was urged on me. I refused because I recalled the identical illness, excruciating pain, etc., when I was a child. It had gone untreated and after two weeks of being unable to eat anything, doubled over, I had gradually recovered. I knew that I would recover this time too, if I were just left alone to do that.

    The hospital staff were apoplectic. I was given antibiotics – because that was all they could do. I was not given painkillers, and they frankly treated me very badly, to coerce me into what they knew I needed to save my life. But very gradually, on the third day, the white blood cell counts and other things began to come down. The appendix did not rupture. I eventually got better.

    So yes, it is possible to survive acute appendicitis without surgery. It is even possible to survive it without antibiotics…but I wouldn’t recommend it.

    May 10th, 2014 5:09 pm

  5. ERDoctor

    Dear Stephen-
    Great story! I believe that the mantra of surgery for acute appendicitis is evolving. We shall see whether in the future all cases will be operated or not. Thanks for your comment.

    Sincerely,

    Rick Tietz, MD

    May 12th, 2014 12:20 pm

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