Surgery for appendicitis: is it necessary?
BACKGROUND
Appendectomy for acute appendicitis is an effective, universally accepted procedure performed more than 300,000 times annually in the United States. It is generally believed that appendicitis progresses invariably from early inflammation to later gangrene and perforation, and that appendectomy is required for surgical source control. Although non-operative management with antibiotics of uncomplicated diverticulitis, salpingitis, and neonatal enterocolitis is now established, the non-operative management of appendicitis remains largely unexplored.


METHODS
Systematic review of published literature and derived expert opinion.


RESULTS
Clinical, epidemiologic, radiologic, and pathologic evidence is presented for spontaneous resolution of uncomplicated acute appendicitis. The pathogenesis of appendicitis is reviewed with specific consideration of the role of bacterial infection in the pathogenesis. Evidence is also provided documenting the clinical success of non-operative management.


CONCLUSIONS
Appendectomy may not be necessary for the majority of patients with acute uncomplicated appendicitis, as many patients resolve spontaneously and others may be treatable with antibiotics alone. However, the supporting documentation is scant and of poor quality. A randomized, prospective trial of non-operative management versus early appendectomy of acute uncomplicated appendicitis corroborated by radiologic imaging is called for.
Mason
Rodney J
RJ
Division of Emergency Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California and Los Angeles County and USC Medical Center, Los Angeles, California, USA. rmason@surgery.usc.edu
D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy / Q000379:methods* / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D002986:Clinical Trials as Topic; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents