Appendectomy versus Antibiotic Treatment in Acute Appendicitis. A Prospective Multicenter Randomized Controlled Trial

Styrud, Johan; Eriksson, S; Nilsson, Ingemar; Åhlberg, Gabrielle; Haapaniemi, Staffan; Neovius, G.; Rex, Lars; Badume, Ibrahim; Granström, L

doi:10.1007/s00268-005-0304-6

Cited by 471 publications

(492 citation statements)

References 17 publications

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“…Five prospective RCTs [27][28][29][30][31] with a total of 1430 patients met the selection criteria and were eligible for inclusion. The number of patients, per protocol, allocated to the antibiotic group was 644, while 786 patients comprised the surgery group.…”

Section: Resultsmentioning

confidence: 99%

“…The most recent RCTs used ertapenem, following the previously published guidelines by the surgical infection society and the infectious diseases society of America for the management of intra-abdominal infection [34]. As for post-discharge antibiotics, four of the five selected studies used a combination of a second or third generation fluoroquinolone; ofloxacin, ciprofloxacin or levofloxacin, and a nitroimidazole; metronidazole or tinidazole [27][28][29]31]. Vons et al continued to use amoxicillin and clavulinic acid.…”

Section: Discussionmentioning

confidence: 99%

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A Meta-Analysis of Antibiotics Versus Surgery for the Treatment of Acute Appendicitis

Madanat¹,

Shaban²,

Naghawi³

et al. 2017

BIO

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Abstract:Appendectomy is the mainstay of treatment for acute appendicitis. Considering the complications of surgery, antibiotic treatment has also been gaining increasing interest in cases of acute appendicitis. This study aimed to compare the efficacy of antibiotics to surgery for acute uncomplicated appendicitis. The PubMed, Medline, Medscape and Cochrane databases were searched for studies comparing antibiotics versus surgery. The six outcome measures identified were thirty-day post-therapeutic peritonitis, length of hospital stay, prevalence of total complications, prevalence of normal appendix, prevalence of mean duration of pain and duration of disability. Five prospective RCTs with a total of 1430 patients (644 in the antibiotic group and 786 in the surgical group) were included in this study. Antibiotic treatment had a success rate of 75.3%. Regarding overall mean duration of disability, the antibiotic group had a significantly shorter duration of disability than that of the surgery group (P < 0.05). The total number of complications in the antibiotic group was 3.6% while that of the surgical group was 11.6%. The overall difference for mean duration of pain, and length of hospital stay between antibiotic therapy and surgery were not found to be statistically significant (P > 0.05). Although the conservative approach has a success rate lower than appendectomy, it is a possible alternative in certain clinical scenarios. Appendectomy remains the mainstay treatment for acute appendicitis. However, additional studies clarifying the certain etiologies of appendicitis that are responsive to antibiotic treatment are needed to further support its use.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Meta-Analysis of Antibiotics Versus Surgery for the Treatment of Acute Appendicitis

Madanat¹,

Shaban²,

Naghawi³

et al. 2017

BIO

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“…Disseminated intra-abdominal infection from appendicitis, however, is not seen as often today as in the first decades of the 20th century, when appendicitis was the major cause of severe peritonitis and peritonitis-related mortality (36,37,38). Although antibiotics may be used as primary treatment for selected patients with suspected uncomplicated appendicitis, appendectomy is still the gold standard therapy for acute appendicitis (36,37,38). Treatment includes source control by appendectomy, rarely in the most severe cases staged abdominal repair in cases when peritoneal edema has led to abdominal compartment syndrome.…”

Section: Source Control Of Appendix Perforationmentioning

confidence: 99%

“…Treatment includes source control by appendectomy, rarely in the most severe cases staged abdominal repair in cases when peritoneal edema has led to abdominal compartment syndrome. Studies have demonstrated that antibiotics alone may be useful to treat patients with early, non perforated appendicitis, even if there is a risk of recurrence (36,37,38). Randomized clinical trial by Hanson et al compared antibiotic therapy versus appendectomy as primary treatment of acute appendicitis (39).…”

Section: Source Control Of Appendix Perforationmentioning

confidence: 99%

Intra-abdominal infection and acute abdomen-epidemiology, diagnosis and general principles of surgical management

Jovanovic¹,

Lončar²,

Doklestić³

et al. 2015

SANAMED

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Intra-abdominal infections are multifactorial and present an complex inflammatory response of the peritoneum to microorganisms followed by exudation in the abdominal cavity and systemic response Despite advances in management and critical care of patients with acute generalized peritonitis due to hollow viscus perforation, prognosis is still very poor, with high mortality rate. Early detection and adequate treatment is essential to minimize complications in the patient with acute abdomen. Prognostic evaluation of complicated IAI by modern scoring systems is important to assess the severity and the prognosis of the disease. Control of the septic source can be achieved either by nonoperative or operative means. Nonoperative interventional procedures include percutaneous drainages of abscesses. The management of primary peritonitis is non-surgical and antibiotic-treatment. The management of secondary peritonitis include surgery to control the source of infection, removal of toxins, bacteria, and necrotic tissue, antibiotic therapy, supportive therapy and nutrition. "Source control" is sine qua non of success and adequate surgical procedure involves closure or resection of any openings into the gastrointestinal tract, resection of inflamed tissue and drainage of all abdominal and pelivic collections.

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“…2,3,[4][5][6] This is review of 283 cases of acute appendicitis undergoing appendicectomy from January 2016 to December 2016 to verify whether acute non-perforated appendicitis requires immediate surgery or can be delayed being taken up on elective basis.…”

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confidence: 99%

Delayed appendicectomy in patients with non-perforated acute appendicitis

et al. 2017

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Background: Appendicitis remains one of the most common diseases encountered by the surgeon in practice. Appendicectomy is the most common urgent or emergency general surgical operation performed. Emergency appendicectomy is believed to be the standard treatment protocol for patients with acute appendicitis. This study was conducted to verify whether acute non-perforated appendicitis requires immediate surgery or can be delayed to be taken up on elective basis.Methods: This is a retrospective study of all the cases undergoing appendicectomy for acute appendicitis over the period of January 2016 to December 2016 in K. R. hospital, Mysuru, Karnataka, India. The cases were divided into two comparison groups: emergency group (operated within 12 hours of admission) and delayed group (operated between 12-72 hours). Parameters like age, sex, duration of symptoms, total leucocytes count, temperature, haemoglobin, radiological investigations, operative procedure, operative time, length of hospital stay, length of post-operative stay were collected and the end points for comparison were: Operative time, perforation rate, post-operative complication, length of hospital stay, readmission rate. Cases of perforated appendicitis in preoperative diagnosis, interval appendicectomy and appendicectomy done in association with other abdominal conditions were excluded from the study.Results: During this one-year period 283 patients have undergone appendicectomy. Out of this 189 (66.8%) patients have undergone surgery within 12 hours of admission and 94 (33.2%) have undergone surgery between 12 to 72 hours of admission. There was no significant difference between the two groups in operative time, per operative perforation rate, post-operative complication rate, readmission rate. Length of the hospital stay was greater in delayed group as compared to emergency group. But there was no significant difference between the post-operative length of hospital stay.Conclusions: Acute appendicitis can be treated surgically in a delayed elective basis without increasing morbidity.

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Appendectomy versus Antibiotic Treatment in Acute Appendicitis. A Prospective Multicenter Randomized Controlled Trial

Abstract: Acute non-perforated appendicitis can be treated successfully with antibiotics. However, there is a risk of recurrence in cases of acute appendicitis, and this risk should be compared with the risk of complications after appendectomy.

Cited by 471 publications

References 17 publications

A Meta-Analysis of Antibiotics Versus Surgery for the Treatment of Acute Appendicitis

A Meta-Analysis of Antibiotics Versus Surgery for the Treatment of Acute Appendicitis

Intra-abdominal infection and acute abdomen-epidemiology, diagnosis and general principles of surgical management

Delayed appendicectomy in patients with non-perforated acute appendicitis

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