Two-thirds of appendix removals 'unnecessary'

Medical dogma and 130 years of tradition mean doctors often wrongly consider surgery to be the only course of action, according to a study published in the British Medical Journal.

Academics say there is good evidence that treating uncomplicated cases of appendicitis with antibiotics tends to be better for the patient than surgery. Uncomplicated appendicitis, where an inflamed appendix has not led to other problems such as perforation of the organ or a serious infection, account for 80% of cases. The rest are complicated cases, where surgery is the only option.

Researchers wanted to see how patients with uncomplicated appendicitis fared if put on antibiotics. They examined four trials that compared the two approaches, which together contained about 900 patients. Volunteers were assigned either antibiotics or surgery on a random basis.

Among those given antibiotics, 80 per cent did not suffer another bout of appendicitis within 12 months of their course. Consequently, just under two thirds (63 per cent) of all appendectomies could be regarded as unnecessary.

The researchers, from the Nottingham Digestive Diseases Centre NIHR Biomedical Research Unit, said that while appendectomy had been the mainstay treatment since it was first reported in 1889, antibiotics had been overlooked. "The role of antibiotic treatment in acute uncomplicated appendicitis may have been overlooked mainly on the basis of tradition," they wrote.

They said routine early appendectomy was based on the dogma that appendicitis is a progressive disease, from an uncomplicated stage to one with complications of gangrene, perforation, or peritonitis, and that any delay in treatment increases the risk of complications.

They concluded: "Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis."

Professor Dileep Lobo, who worked on the study, said: "If your doctor thinks you have uncomplicated appendicitis, there's no harm in putting you on antibiotics and observing you. There's a good chance you are going to get better."

Those who did not could still have an operation if things did not improve, he added.

He added that of the 20 per cent of patients who did have a recurrence of appendicitis in a year, "only about one in five patients develop complicated appendicitis" requiring surgery.

Dr Olaf Bakker from the Department of Surgery at the University Medical Centre in Utrecht said treating appendicitis with antibiotics had major certain disadvantages.

In particular, he said one in five patients having appendicitis again within 12 months was quite a high proportion.

Until more convincing and longer term results were published, "appendectomy for uncomplicated appendicitis will probably continue", he said.

There are about 47,000 appendix removals on the NHS each year.