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Removal of inflamed appendix not always necessary

Removal of inflamed appendix not always necessary

Treatment with antibiotics is often sufficient for curing acute appendicitis, scientists of the Amsterdam Medical Centre write in Surgery. In a small prospective cohort study, the researchers monitored the clinical course of simple appendicitis in children treated with antibiotics instead of appendectomy.  

The removal of the appendix is historically based on the idea that appendicitis is an irreversibly progressive disease. However, the current notion comprises the existence of two different types: a simple appendicitis curable with antibiotics and a complex appendicitis which has to be resected due to perforation risks.

The study included 25 children between the ages of seven and seventeen with a simple appendicitis who were treated with intravenous amoxicillin, clavulanic acid and gentamicin during two to three days. Every six hours, the patients were clinically reevaluated, in combination with daily blood samples and ultrasound investigation. In case of improvement, the participants were sent home with a seven-day oral antibiotic treatment. Only 2 of the 25 children needed an appendectomy after all, because of clinical deterioration. Furthermore, no adverse events or recurrences were observed during the eight-week follow-up.

The author, scientist Ramon Gorter from the Pediatric Surgical Centre of Amsterdam, says: “The benefits of surgery have already been doubted in adults for some time. However, this is one of the first studies with children, who constitute the majority of appendectomy patients. We would like to expand the research to more hospitals and more children to confirm the feasibility of our method in practice. If it succeeds, we want to adjust the guidelines for children with a simple appendicitis.”

Gorter continues: “The basic rule in surgery is to only make an incision if there are no alternatives.” This way, patients are not subjected to unnecessary risks. Additionally, the appendix seems to be not as useless as generally thought. Gorter explains: “Several studies have indicated its function. Apparently, it plays a role in the immune system of the bowel. Another advantage are the lower costs of an antibiotics treatment. Taken together, I would say: if possible, leave it alone.”

Sources: AMC, Surgery

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