- An appendectomy is one of the most common procedures performed by the NHS
- Researchers say the only risk of not having surgery is that appendicitis will come back later
Operations to remove an appendix could soon be a thing of the past.
Swedish experts claim that when the mysterious, worm-shaped organ becomes infected, appendicitis can be effectively treated with antibiotics.
It could mean the end of appendectomies, one of the most common NHS procedures.
Rapid removal of the appendix has been the standard of care for over a century.
However, researchers at the Karolinska Institute argue that the only risk of not having surgery and relying on antibiotics is a recurrence of appendicitis.
Swedish experts say the only risk of not having surgery and relying on medication instead is that appendicitis will come back. Their analysis of the evidence found that fewer than half of those treated with antibiotics were knocked down again
The researchers, from the Karolinska Institute in Stockholm, used data from two random controlled trials in the Swedish National Patient Registry. Pictured: Archival image highlighting the location of an inflamed appendix
The findings come against the backdrop of subtle efforts to reduce the cost of NHS inpatient treatment and the number of unnecessary procedures performed.
The team wrote in the journal JAMA Surgery, “The present data will be useful to both physicians and patients in making treatment decisions.”
Experts analyzed two separate studies that looked at the outcomes of 292 patients hospitalized with appendicitis.
The condition, which causes stomach pain that radiates to the lower right side, can be life-threatening without prompt treatment.
In the first study, 40 people were divided into two groups. Half received an appendectomy.
WHAT IS APPENDICITIS?
Appendicitis is a swelling of the appendix, an organ two to four centimeters long that is connected to the large intestine.
Appendicitis can cause severe pain and needs to be treated quickly if the appendix ruptures, which can lead to life-threatening conditions.
In most cases, surgeons remove the appendix during appendectomy. Scientists aren’t sure why people need an appendix, but removing it doesn’t harm people.
The causes of appendicitis aren’t clear, but it’s thought to be caused by something blocking the entrance to the organ.
Symptoms include pain in the stomach, which later spreads to the lower right side and becomes severe.
Pressing, coughing, or walking on this area can make the pain worse. Other symptoms can include nausea, vomiting, loss of appetite, diarrhea and fever.
Source: NHS
The others were given antibiotics for 10 days and all but one made a successful recovery.
In the second, larger study, however, the success rate was 86 percent.
Combining the results of both studies found that 40 percent of patients treated with antibiotics actually later required an appendectomy.
The researchers wrote, “More than half of the patients treated nonsurgically did not recur and avoided surgery for approximately two decades.”
“There is no evidence of any long-term risks of nonsurgical treatment other than the risk of recurrence of appendicitis.”
However, they found that the diagnostic standards of the operations of the time differed from those of today.
Medical professionals are now doing “much higher imaging rates,” they added, which means fewer patients are being misdiagnosed with appendicitis.
Around 50,000 people are hospitalized with appendicitis in England each year, according to the NHS.
Approximately 11.6 million cases of appendicitis are reported annually in the United States.
If left untreated, the disease can be fatal.
During surgery, the appendix is removed from the body after doctors make three or four small incisions in the abdomen.
The incisions are closed with staples or sutures.
After routine surgery, most patients can go home the next day and return to their normal activities after a week.
But as with any surgery, there are risks. About every tenth patient suffers side effects from the operation itself, such as a skin infection.
In recent years, several European studies have shown that most people with appendicitis can be successfully treated with antibiotics instead of undergoing surgery.
Seven years ago, experts said it was “time to think about abandoning routine appendectomy.”
Hundreds of children have their organs removed unnecessarily every year.