How antibiotics could replace surgery for treating appendicitis

Good news for doctors looking to cut appendectomies out of their schedules.

A new study — conducted by Swedish researchers from the Karolinska Institute and published Wednesday in JAMA Surgery — found that most patients who receive antibiotics for appendicitis rather than surgery have successful long-term outcomes, but some may require surgery later on.

Appendectomies are among the most common surgical procedures in the US. Appendicitis — inflammation of the appendix, with warning signs that include intense pain near the belly button that travels to the lower right side — can be fatal if not treated. Humans can survive without an appendix, making surgery the standard treatment.

The Swedish study analyzed data from 292 patients hospitalized with appendicitis in two trials undertaken in the 1990s by the Swedish National Patient Registry. 

Forty patients were divided into two groups, those who received antibiotics for 10 days and those who underwent surgery. Only one person in the antibiotic group did not successfully recover. The second, larger study boasted a success rate of 86%.

The findings from both studies show that 40% of the patients treated with antibiotics required surgery later in life.

“More than half of the patients treated nonoperatively did not experience recurrence and avoided surgery over approximately two decades,” the study authors wrote. 

“There is no evidence for long-term risks of nonoperative management other than that of recurrence of appendicitis.”

The authors noted their research has limitations. Since the study utilized old data, they couldn’t track how patients’ circumstances changed over time.

They also pointed out that diagnostic imaging in the 1990s is less advanced than it is today.

An appendectomy also may not be needed if patients don’t seem to have an appendix at all. Last year, a woman said she went to the doctor with stomach pain and later discovered her appendix was “missing.”