Appendectomy versus antibiotic treatment for acute appendicitis

Wilms, Ingrid MHA; Hoog, Dominique Enm Suykerbuyk-de; Visser, Dianne C de; Janzing, H

doi:10.1002/14651858.cd008359.pub2

Cited by 169 publications

(155 citation statements)

References 26 publications

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“…These data have been mirrored by success of non-operative treatment in children who have had symptoms for three or more days, or absence of diffuse peritonitis, bowel obstruction or mass; moreover, failure of conservative treatment has not been associated with increased morbidity [119]. Subsequent meta-analyses and Cochrane reviews in the 2010s revealed that antibiotics was safe in the majority of patients with uncomplicated appendicitis [51, [120][121][122].…”

Section: Discussionmentioning

confidence: 99%

Review of Operative vs. Non-Operative Management of Appendicitis in Pregnancy

Blears¹,

Keller²,

Ellis³

2017

Surgery Curr Res

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The last decade has marked a paradigm shift in the care for acute appendicitis in children and non-pregnant adults. Although surgical management remains the safest treatment modality for perforated or complicated appendicitis, antibiotic therapy has been proven to be safe in adult and pediatric patients with non-perforated appendicitis. However, controversy exists for the type of surgery (laparoscopic vs. open) and the post-operative antibiotic regimens which result in optimal patient care of pregnant as well as non-pregnant adults. As several authors have begun to evaluate a non-operative strategy for treating acute appendicitis, whether with antibiotic therapy alone or combined with image-guided percutaneous drainage, others have retrospectively analyzed these strategies to pregnant women with abdominal pain. This collective review presents the epidemiology and diagnostic challenges of acute appendicitis in the pregnant patient and a review of the data that supports non-operative management in non-pregnant adults and pediatric patients as well as the limited data that supports non-operative management in pregnant adults.

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Section: Discussionmentioning

confidence: 99%

Review of Operative vs. Non-Operative Management of Appendicitis in Pregnancy

Blears¹,

Keller²,

Ellis³

2017

Surgery Curr Res

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“…However, the Cochrane review showed that, due to the lowmoderate quality of studies, only minor complications in the two groups can be truly compared [20].…”

Section: Efficacymentioning

confidence: 99%

“…The same rationale of approach can be useful in the setting of surgically high risk patients [20,30]. In 2012 Tugnoli and collaborators, from Italy, reported the preliminary results of a prospective observational study on the non-operative treatment for acute appendicitis (NOTA-study): they found a relapse rate of AA at six months of 8.3%: patients with new episode of AA mandate surgery [31,32].…”

Section: Potential Advantages Of Non-surgical Treatmentmentioning

confidence: 99%

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Conservative treatment for uncomplicated acute appendicitis in adults

Pisano¹,

Coccolini²,

Bertoli³

et al. 2013

Emerg Med Health Care

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Background: Acute appendicitis is a very common disease with a life time risk of approximately 7-8%. Worldwide, the standard of care for appendicitis is appendectomy that is to date considered generally a "routine and safe operation". However, the mortality rate of appendectomy is 0.7% and 2.4% in patients without and with perforation, respectively. Aim: The paper aims to investigate the debate on surgical and non surgical treatment of acute uncomplicated appendicitis. Methods: Pubmed and embase were queried for "acute appendicitis, antibiotics, surgery, conservative treatment, diagnosis". All prospective randomized studies, meta-analysis, systematic reviews and significant retrospective studies were retrieved. A brief analysis of single RCT and meta-analysis was conducted. Finally, the topic was developed by focusing on several clinical aspects. Discussion and conclusions: The comparison of surgery and antibiotics, in terms of efficacy to treat acute appendicitis, is intrinsically complex due to the huge disparity of management and treatment options. After establishing an institutional validated clinical score, uncomplicated appendicitis in adult can be safely and successfully treated by antibiotic therapy an in-hospital setting if the patient is well informed. Nevertheless, outpatient antibiotic treatment cannot be proposed as a routine clinical practice. High risk patients should be treated with antibiotics whilst any treatment failure should be considered for mandatory surgery.

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“…Postoperative pain is usually lower after LA, whereas diet for bowel recovery (occurring after 12-84 h) and length of hospital stay are equal or better after LA as compared to OA [2,5,8,9]. …”

Section: Acute Appendicitis: Laparoscopic Approachmentioning

confidence: 99%

Appendicitis/Diverticulitis: Minimally Invasive Surgery

Mutter

Marescaux

2013

Dig Dis

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Complicated intra-abdominal infections such as acute appendicitis and complicated diverticulitis represent both diagnostic and therapeutic challenges. Both diseases, although different in many ways, are caused by the obstruction of a blind pouch leading to inflammation, abscesses, and perforation of surrounding tissues. For many decades, acute appendicitis was managed through a conventional surgical incision in the right iliac fossa. As for other diseases, there is a significant tendency to propose less invasive treatments. For many teams, laparoscopy, which leads to less postoperative pain, a shorter hospital stay, and a quicker recovery, represents the standard of care for appendectomy. For selected cases, a medical approach can be proposed with satisfactory outcomes. Additionally, the management of complicated diverticulitis is also quickly moving towards less invasive procedures than the deleterious ‘3-phase surgery', which is Hartmann's procedure, followed by reversal protected with a stoma, and finally stoma closure. Benefiting from the evolution of antimicrobial therapy and interventional radiology, many complicated cases classified as Hinchey stage I and Hinchey stage II complicated diverticulitis are now treated medically. CT images allow the identification of patients requiring radiological drainage of localized abscesses or collections over 5 cm in size. Patients with Hinchey stage III sigmoiditis may benefit from an initial laparoscopic exploration allowing, in some cases, a conservative nonresective approach that will prevent laparotomy and stoma. Major resection leading to temporary or definitive stoma is usually indicated for stage IV complications and is required only in exceptional cases. Although a surgical intervention can be the definitive treatment for complicated intra-abdominal infections, multidisciplinary management including radiology, medical treatment, and laparoscopic surgery may limit the severe consequences of an acute surgical approach in patients suffering from complicated appendicitis and diverticulitis. Today, the ultimate goal of acutely infected abdomen management is to reduce hospital stay, disability, and numerous operations for these patients.

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Appendectomy versus antibiotic treatment for acute appendicitis

Cited by 169 publications

References 26 publications

Review of Operative vs. Non-Operative Management of Appendicitis in Pregnancy

Review of Operative vs. Non-Operative Management of Appendicitis in Pregnancy

Conservative treatment for uncomplicated acute appendicitis in adults

Appendicitis/Diverticulitis: Minimally Invasive Surgery

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