7 in 10 appendix patients ‘do not need operations’

OPERATIONS for appendicitis may be unnecessary in most cases, a major study has found.

Antibiotics were as effective as taking out the appendix for 70 per cent of patients. For the remaining 30 per cent the operation can be a last resort.

Removal through a procedure called an appendectomy has been in clinical use for more than a century.

Around 70,000 are carried out every year in Britain to solve problems when the appendix, part of the digestive tract, becomes infected and inflamed.

But the study of 1,500 patients, led by the University of Washington in Seattle, found 70 per cent of those who took antibiotics as a first-line treatment did not require surgery. Half of them did not even require admission to hospital.

Around 30 per cent of those given antibiotics needed an operation within three months, according to results published in the New England Journal of Medicine. Other research suggests that delaying surgery to try antibiotics is no worse than having an operation in the first place.

Dr David Talan of the University of California, Los Angeles, co-led the trial. He said: ‘When we compared the outcomes of people treated with antibiotics alone or surgery to remove the appendix, we found that people receiving either treatment felt well at 30 days. In terms of overall health status, antibiotics were no worse than surgery and allowed most people to avoid an operation in the short term.’

Fellow researcher Bonnie Bizzell, of Washington State Hospital Association, said: ‘People treated with antibiotics more often returned to the emergency department, but missed less time from work and school.

‘Information like this can be important for individuals as they consider the best treatment option for their unique circumstance.’

The research team, which presented its findings at the clinical congress of the American College of Surgeons, said each patient should still be carefully assessed, because surgery will be better in some cases.

Trial co-leader Dr David Flum, of the University of Washington school of medicine, said: ‘There were advantages and disadvantages to each treatment, and patients will value these differently based on their unique characteristics, concerns, and perspectives.’

The UK’s National Institute for Health and Care Excellence, which gives doctors guidance about best medical practice, does not issue recommendations on the best way to treat appendicitis.