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No Appendectomy for Appendicitis?

treatment for appendicitis

For more than 100 years, the primary treatment for appendicitis has remained virtually unaltered: surgery.

The appendix, a finger-shaped pouch attached to the large intestine (or colon), was previously thought to be vestigial – or functionless – before studies showed that it actually harbors healthy bacteria. These bacteria haven been proven to replenish the gut after bouts of diarrhea, reinforcing the argument for holding onto this organ as long as humanly possible.

Appendicitis develops when this organ becomes blocked and subsequently inflamed. It most frequently occurs in children and young adults, and more often in males. It is the most common emergency surgical procedure, and laparoscopy is the most common way it is performed. Approximately 300,000 individuals receive the procedure each year.

But that is gradually changing.

Because almost 80% of appendicitis cases are mild, or uncomplicated, many pediatric providers are urging a “wait and watch” approach for children, barring the threat or presence of a rupture.

In many cases, the appendix turns out to be:

  • Non-inflamed, making surgery unnecessary
  • Unobstructed, meaning that nothing was wrong to begin with
  • Or self-limiting, and responsive to antibiotics, alone

For the latter reason, specifically, specialists are increasingly endorsing the administration of antibiotics in simple to mild cases of appendicitis. However, because antibiotics most often used in these cases are broad-spectrum, this course of treatment is not without its own concerns. And although studies have shown that children with appendicitis who are treated with antibiotics did not have any adverse side-effects, approximately one third were susceptible to a relapse of the infection later on.

While pediatricians do not advocate non-treatment in any way, the pros and cons of surgical intervention must be weighed on a case-by-case basis. Watchful waiting, with antibiotic treatment, may be appropriate for certain individuals, but not all.

The bottom line is that the decision is one that must be made with your provider, and following thoughtful discussion – not a kneejerk reaction.

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