Daniela Prechal1,2, Stefan Post2, Ioanna Pechlivanidou2, Ulrich Ronellenfitsch3,4. 1. Medical Faculty Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany. 2. Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. 3. Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. ulrich.ronellenfitsch@uk-halle.de. 4. Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany. ulrich.ronellenfitsch@uk-halle.de.
Abstract
PURPOSE: Based on results from randomized controlled trials, there is an increasing discussion if antibiotic treatment is an equivalent therapeutic approach to appendectomy in uncomplicated acute appendicitis. This observational prospective study evaluates its feasibility, safety, and effectiveness in clinical practice. METHODS: The study included all consecutive adults treated for acute appendicitis over an 18-month period in one hospital. Patients receiving antibiotics were compared to those treated surgically. Follow-up comprised 1 year. The primary endpoint was treatment success, defined as no secondary appendectomy during follow-up (antibiotic group) or successful appendectomy (primary surgical group). Secondary endpoints were complications, duration of hospital stay, pain intensity, and length of absence from work. RESULTS: 54/124 (43.6%) patients were primarily treated with antibiotics and 70/124 (56.4%) surgically. Treatment success at 1 year was 77.1% (95%-CI 62.8-88%) for antibiotic and 100% for surgical treatment. Complications were non-significantly less frequent both among all patients treated with antibiotics and among patients undergoing secondary appendectomy compared to patients undergoing primary appendectomy (20.8% vs. 27.1% and 9.1% vs. 27.1%). The initial hospital stay was significantly shorter in the antibiotic group (mean 3.6 vs. 4.8 days, median 3 days, p = 0.03). After 1 year, the cumulative hospital stay was not different between groups. CONCLUSIONS: Appendectomy remains the most effective treatment for the definitive cure of acute appendicitis. However, antibiotic therapy can be a safe alternative approach for selected patients with uncomplicated acute appendicitis. TRIAL REGISTRATION: DRKS00010401.
PURPOSE: Based on results from randomized controlled trials, there is an increasing discussion if antibiotic treatment is an equivalent therapeutic approach to appendectomy in uncomplicated acute appendicitis. This observational prospective study evaluates its feasibility, safety, and effectiveness in clinical practice. METHODS: The study included all consecutive adults treated for acute appendicitis over an 18-month period in one hospital. Patients receiving antibiotics were compared to those treated surgically. Follow-up comprised 1 year. The primary endpoint was treatment success, defined as no secondary appendectomy during follow-up (antibiotic group) or successful appendectomy (primary surgical group). Secondary endpoints were complications, duration of hospital stay, pain intensity, and length of absence from work. RESULTS: 54/124 (43.6%) patients were primarily treated with antibiotics and 70/124 (56.4%) surgically. Treatment success at 1 year was 77.1% (95%-CI 62.8-88%) for antibiotic and 100% for surgical treatment. Complications were non-significantly less frequent both among all patients treated with antibiotics and among patients undergoing secondary appendectomy compared to patients undergoing primary appendectomy (20.8% vs. 27.1% and 9.1% vs. 27.1%). The initial hospital stay was significantly shorter in the antibiotic group (mean 3.6 vs. 4.8 days, median 3 days, p = 0.03). After 1 year, the cumulative hospital stay was not different between groups. CONCLUSIONS: Appendectomy remains the most effective treatment for the definitive cure of acute appendicitis. However, antibiotic therapy can be a safe alternative approach for selected patients with uncomplicated acute appendicitis. TRIAL REGISTRATION: DRKS00010401.
Authors: Johan Styrud; Staffan Eriksson; Ingemar Nilsson; Gunnar Ahlberg; Staffan Haapaniemi; Gunnar Neovius; Lars Rex; Ibrahim Badume; Lars Granström Journal: World J Surg Date: 2006-06 Impact factor: 3.352
Authors: Paulina Salminen; Hannu Paajanen; Tero Rautio; Pia Nordström; Markku Aarnio; Tuomo Rantanen; Risto Tuominen; Saija Hurme; Johanna Virtanen; Jukka-Pekka Mecklin; Juhani Sand; Airi Jartti; Irina Rinta-Kiikka; Juha M Grönroos Journal: JAMA Date: 2015-06-16 Impact factor: 56.272
Authors: Gianfranco Cervellin; Riccardo Mora; Andrea Ticinesi; Tiziana Meschi; Ivan Comelli; Fausto Catena; Giuseppe Lippi Journal: Ann Transl Med Date: 2016-10
Authors: S Sippola; J Grönroos; R Tuominen; H Paajanen; T Rautio; P Nordström; M Aarnio; T Rantanen; S Hurme; P Salminen Journal: Br J Surg Date: 2017-07-05 Impact factor: 6.939