Is Appendicectomy Becoming Obsolete: A Review
Keywords:
Appendicitis, Conservative, OperativeAbstract
Introduction: Appendicectomy has long been the chosen method for treating acute uncomplicated appendicitis; recently however, there has been debate about whether antibiotic therapy can provide a similar level of treatment. The primary aim of this review is to compare the efficacy of surgical and non-surgical interventions for acute uncomplicated appendicitis.
Methods: Relevant databases were searched for systematic reviews comparing appendicectomy against antibiotic therapy for treatment of acute uncomplicated appendicitis. The primary outcome for antibiotic therapy was improvement without recurrence of acute appendicitis within a median follow-up of one year. For surgical treatment it was confirmed appendicitis at operation with no subsequent need for surgery for acute appendicitis. The secondary outcomes include percentage of patients experiencing post-treatment complications, mean C-reactive protein on admission, and mean length of hospital stay.
Results: Eight systematic reviews satisfied the inclusion criteria. Of the 1169 patients initially treated with antibiotic therapy, 759 patients (64.93%) did not need follow up treatment within one year. This was compared to a 94.17% efficacy rate in the surgical group. There was a minor difference between post-treatment complication rates in the antibiotic and surgical groups (7.26% and 16.27%, respectively). No clear difference was found between C-reactive protein and length of hospital stay.
Discussion: This analysis shows that appendicectomy has a greater efficacy than antibiotic therapy for definitive treatment of acute uncomplicated appendicitis. However, because the rate of post-
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