Are antibiotics an effective initial treatment for acute appendicitis compared to appendectomy?

Area of Science:

• Gastroenterology
• Surgical Innovation
• Evidence-Based Medicine

Background:

• Acute appendicitis is a common surgical emergency.
• Appendectomy is the traditional treatment.
• Antibiotic therapy is emerging as a non-operative alternative for select patients.

Purpose of the Study:

• To review a meta-analysis comparing antibiotic therapy and appendectomy for acute appendicitis.
• To evaluate complication rates and treatment outcomes.

Main Methods:

• Individual patient data meta-analysis of six randomized controlled trials.
• Included 2101 adult patients with imaging-confirmed acute appendicitis.
• Intention-to-treat analysis with mixed-effects modeling; complications classified by Clavien-Dindo.

Main Results:

• No significant difference in overall, major, or minor complication rates at one year between antibiotic and appendectomy groups.
• 34% of antibiotic-treated patients required delayed appendectomy; 25% had complicated appendicitis.
• Patients with appendicoliths had higher complication rates (49% required surgery).

Conclusions:

• Antibiotic therapy is a reasonable initial approach for uncomplicated acute appendicitis.
• Patient understanding of risks is crucial.
• Caution is advised for appendicitis with appendicoliths due to higher failure rates.