London - It is one of the most common surgical procedures. But the days of having an appendix removed could soon be over.
Experts called for routine operations to be abandoned after a study showed that treating appendicitis with antibiotics could be just as effective.
The current operation – called an appendectomy – is carried out around 70 000 a year when the appendix, part of the digestive tract, becomes infected.
If left untreated, the condition can be fatal.
Swift removal has been the standard treatment for more than a century.
But that could change after doctors experimented with treating the condition with antibiotics instead, and discovered only complex cases should require surgery.
The results of the trial, published in the Journal of the American Medical Association (JAMA), found the majority of patients who were treated with antibiotics did not require a later operation.
The researchers, from Turku University Hospital, in Finland, randomly divided 530 patients with appendicitis into two groups. Half received an appendectomy, with all but one recovering successfully. The other half were instead given antibiotics for ten days, after which 73 percent recovered fully while the remaining 27 percent then had their appendix removed.
Follow-up tests showed that those who had received anti-biotics first and then had the delayed operation had no complications when compared to those who had the operation straight away.
The study authors wrote: “These results suggest that patients should be able to make an informed decision between antibiotic treatment and appendectomy.”
Doctors warned that patients with symptoms of appendicitis should continue to seek emergency help at a hospital as the condition can quickly become life-threatening.
But experts called for a rethink of the way appendicitis is treated. Dr Edward Livingston, deputy editor of JAMA, and expert Dr Corrine Vons of the Jean-Verdier Hospital in Paris, said routine appendectomies should be stopped. Writing in the journal, they said: “The time has come to consider abandoning routine appendectomy for patients.
“The operation served patients well for more than 100 years. With development of more precise diagnostic capabilities like CT [scans] and effective broad-spectrum antibiotics, appendectomy may be unnecessary for uncomplicated appendicitis, which now occurs in the majority of appendicitis cases.”
Nice – the National Institute for Health and Care Excellence – which gives British doctors guidance about best medical practice, said it had no current guidance on appendicitis.
A spokesperson said: “If we are asked by the Department for Health to produce guidance on this issue, we will look at all the best available evidence.”
John Abercrombie, council lead for emergency general surgery at the Royal College of Surgeons, said: “Antibiotic treatment is already offered by many British surgeons to patients who have an uncomplicated appendicitis. Severe appendicitis remains a potentially very serious illness that requires surgical treatment.”
Daily Mail