Pros and Cons of Appendicitis Treatment Without Surgery

Surgery is widely viewed as the standard course of treatment for appendicitis. For some people, it may not be the only way to solve the problem. Research shows that you may be able to treat appendicitis without surgery.

Certain antibiotics may work as well as surgery. These drugs may be used to treat severe symptoms in order to postpone or avoid surgery. Antibiotics may help when the appendicitis is not complex or the appendix does not pose the threat of bursting (rupturing).

This article describes what is involved in treating appendicitis without surgery, along with the pros and cons, and when it may be the right course of action.

Appendicitis Treatment Without Surgery

Up to 70% of people with appendicitis choose treatment without surgery. Research indicates that antibiotics work as all as surgery and may be an option for people with an uncomplicated appendix infection.

Surgery remains the first-line therapy for people with an appendix at risk of rupture due to inflammation or other complications, but people with uncomplicated appendicitis may be good candidates for the antibiotics option. This nonsurgical approach may also be valuable for people with severe symptoms whose age or other conditions may increase the risk of surgery.

While there is no standardized regimen, the following antibiotics are used in treating appendicitis:

• Augmentin (amoxicillin/clavulanate)
• Zosyn (piperacillin/tazobactam)
• Rocephin (ceftriaxone)
• Ciloxan (ciprofloxacin)
• Invanz (ertapenem)
• Principen (ampicillin)
• Flagyl (metronidazole)

Appendicitis treatment without surgery involves the following pros and cons:

Pros

The benefits of nonsurgical appendicitis treatment include:

• Less risk: Treatment with antibiotics avoids the risk of morbidity (death) and complications that can occur with any type of anesthesia and surgery. It also avoids the risks of undergoing an appendectomy with a ruptured appendix, which can involve an intra-abdominal abscess or infection of the incision.
• Suitable for older people: Appendicitis treatment without surgery may be suitable for adult patients with a high risk of operative complications. Older people who undergo an appendectomy have a higher risk of intraoperative perforation and/or abscess and postoperative intra-abdominal abscess than younger people.
• Avoid negative appendectomy: Leaving your appendix intact avoids the possibility of a negative appendectomy, which is the removal of a normal appendix.
• Recuperation is faster: People treated with antibiotics are more likely to miss fewer days of work and resume leisure activities sooner than those who pursue surgery, according to research comparing the results of surgery and antibiotics treatment.
• Cost-effective approach: The overall cost of appendicitis treatment without surgery is lower compared with appendectomy at short-term follow-up.
  

Cons

The drawbacks of appendicitis treatment without surgery include:

• Higher rate of recurrence: The surgical removal of your appendix prevents the possibility of recurrence. However, treatment with antibiotics does not involve a definitive outcome. Recurrence of appendicitis ranges from 0% to 40% after treatment with antibiotics, resulting in the need for additional treatment or an appendectomy at a later time.
• Longer hospital stays: Studies indicate that people treated with antibiotics are more likely to spend more time in the hospital than those who have had an appendectomy. This is likely due to the treatment administered, which usually involves three to five days of intravenous (IV) therapy vs. the next-day discharge common with an appendectomy.
• Missed opportunity to discover other diseases: An appendectomy allows surgeons to discover conditions that mimic the symptoms of appendicitis. These issues can include cecal neoplasm (a tumor in the area connecting the small and large intestines) and malignancies like carcinoid tumors (slow-growing cancer that can develop in may places in the body), which can be missed with antibiotic treatment.
• The potential risk of antibiotic resistance: A review of related research indicates no standardized antibiotic regimen for treating appendicitis. There is an increased public health threat of antimicrobial resistance with the use of empirical broad-spectrum antibiotics over time can lead to the growth of resistant strains of bacteria.
• Longer follow-up: Appendicitis treatment without surgery can involve a longer follow-up period. A higher recurrence rate can require subsequent antibiotics or an appendectomy.
  

Appendectomy vs. Antibiotics: Which Is Better?

Whether an appendectomy or antibiotics is better depends on your symptoms and other factors regarding your overall condition.

You will likely have to choose between these two treatments soon after your diagnosis. An infected appendix can rupture 48 to 72 hours after symptoms begin. If this occurs, the appendix leaks the infected substance into the lining of your abdomen, which can damage other organs.

You can experience acute or chronic appendicitis. Knowing which type you have is important in determining the type of treatment that is the better option.

For Acute Appendicitis

Acute appendicitis is a sudden inflammation of the appendix. It is one of the most common surgical emergencies. People who have acute appendicitis usually have the following symptoms, which progress rapidly anywhere from a few hours up to two days:

• Appendix pain that begins near the navel and moves to the right lower abdomen
• Loss of appetite
• Nausea
• Diarrhea or constipation
• Vomiting
• Low-grade fever
• Distension (swollen abdomen)

Ultrasound and/or CT (computed tomography) scans are the methods of diagnosis used to confirm appendicitis.

Acute appendicitis can be categorized as either complicated or not. Complicated appendicitis requires treatment with surgery. This condition usually has one of the following characteristics:

• Perforated appendicitis (ruptured appendix)
• Periappendicular abscess (severe complication with a high morbidity rate)
• Peritonitis (inflammation of the lining of your abdomen)

You may be eligible for antibiotic therapy if your condition is not deemed complicated or at risk of perforation for other reasons. While effective, the rate of recurrence is higher than surgery.

In a five-year follow-up of patients with uncomplicated acute appendicitis who were treated with antibiotics, researchers indicated that appendicitis recurred 27.3% at one year, 34% at two years, 35.2% at three years, 37.1% at four years, and 39.1% at five years.

For Chronic Appendicitis

Chronic appendicitis occurs much less often than acute appendicitis and accounts for just 1.5% of all cases. Unlike acute appendicitis—which happens once and is often resolved—chronic appendicitis involves milder symptoms, though recurrent and chronic.

Symptoms of chronic appendicitis last for seven days or longer or come and go for longer.

The condition is believed to occur due to a partial and/or short-term obstruction in the appendix. Since people do not often present with typical appendicitis, misdiagnosis is common. It is also complicated because there are no diagnostic criteria for chronic appendicitis.

While chronic appendicitis is not well-understood, it is thought to occur due to the appendix's partial and/or transient obstruction. With frequent misdiagnosis, complications that require surgery can develop.

When chronic appendicitis does not advance to the need for emergency surgery, antibiotics may be used as a first-line treatment to resolve the problem without surgery. If the problem persists, an appendectomy is recommended.

Making the Best Decision

In making the best decision for yourself regarding treatment for appendicitis, it's important to remember that every case is different. Factors such as the extent of your appendicitis infection and consideration of your age and any other medical conditions you may have can affect the type of treatment advised by your healthcare team.

If you want a cure despite a longer recuperation time, you may be more comfortable with immediate surgery. However, if your goal is to avoid surgery as your initial treatment, and you are comfortable with the possibility of a second round of treatment or surgery at a later date, you may choose antibiotic treatment.

As you weigh your options, ask your healthcare provider the following questions about your treatment choices:

• Do I have appendicitis?
• What other conditions that mimic appendicitis have been ruled out?
• Do I need an appendectomy?
• If I need an appendectomy, will it require open abdominal surgery or a laparoscopy (minimally invasive surgery)?
• Can I safely delay surgery with antibiotic treatment?
• Does my age or other factors increase my risk of complications with an appendectomy?
• What will my recovery involve after an appendectomy?
• How soon can I return to normal activities after an appendectomy versus treatment with antibiotics?
  

Summary

The first-line treatment for appendicitis (an inflamed appendix) has long been surgery. Recent research shows that some people may be able to solve the problem with certain drugs.

Your healthcare provider can advise you on which treatment may be better for you. You may have to choose whether you prefer surgery without the worry of repeat disease or drugs without the risk of surgery.