Inflamed appendix? It might be better to leave it in

    9 February 2017

    Appendicitis surgery in children is unnecessary in many cases, according to a study in the Lancet Gastroenterology and Hepatology journal.

    Researchers at Southampton Children’s Hospital have found that treating the problem with antibiotics alone was sufficient in many more cases than previously thought. They say that three quarters of cases of ‘appendix mass’, or an inflamed appendix, could be safely treated without surgery.

    Although the procedure is generally safe, there are severe complications in seven per cent of appendicectomy surgeries.

    The researchers studied appendicitis cases in 102 children at 17 hospitals in Britain. Fifty of those patients had surgery and 52 were closely monitored having been treated with antibiotics.

    The researchers found that only 12 per cent of those who did not receive initial surgery saw proven appendicitis return, and 23 per cent had to have an operation within a year.

    Nigel Hall, the study’s lead author, said: ‘Up until now more than two thirds of surgeons were routinely recommending interval appendicectomy. Yet the justification for this surgical intervention has never been prospectively challenged.

    ‘Experts had previously assumed roughly a fifth of cases of appendicitis would return if the appendix was not removed. But we have shown that the figure is much lower. This calls into question the justification for surgery as standard practice.

    ‘Although the risk of complications after interval appendicectomy is low, they can be severe. Adoption of a wait-and-see approach, reserving appendicectomy for those who develop recurrence or recurrent symptoms, results in fewer days in hospital, fewer days away from normal daily activity and is cheaper than routine interval appendicectomy.

    ‘This study will allow clinicians, parents and children to make an evidence-based decision regarding the justification for interval appendicectomy and, in many cases, remove the need for surgery completely.’

    Instant analysis
    It is important to make clear that this study is not based on whether or not to treat acute appendicitis with emergency surgery, something that isn’t immediately obvious from the news stories.

    It actually looked at the proportion of children developing recurrent acute appendicitis or recurrent appendix mass within a year after successful (non-operative) treatment of appendix mass.

    So essentially it was trying to establish whether or not surgery should be carried out routinely to prevent recurrence in those who have had their appendicitis successfully treated without surgery already.

    This is still, of course, important to establish, and the results are interesting, with a low recurrence rate in those who did not have surgery. The study size was just over 100 children, and the outcome was measured at one year; it would be interesting to see if recurrence rates increase after that time or remain the same.
    Research score: 3/5