Many people, if given the option, would rather avoid surgery whenever possible. Going under the knife can be a scary prospect when you consider the chances for complications.
So when some new alternative to surgical treatment presents itself, you can be sure that there will be interest in it, especially with a condition as serious and potentially dangerous as appendicitis.
The appendix is a small, finger-shaped organ located in the lower right part of the abdomen, connected to the large and small intestines by a small pouch called the cecum. We don’t have a clear understanding of what the organ does, if anything at all. In fact, the longstanding medical consensus is that the appendix is a vestigial organ, having lost its purpose long ago.
There is new science to suggest that the appendix may play a role in the maintaining a healthy immune system, digestive health, and the body’s gut flora (the complex community of microorganisms that live in our digestive tracts). While the science is still out on its proper function, we are certain about what can happen when the appendix isn’t behaving as it should.
There are a number of ways that the hollow portion of the appendix can become blocked, such as a viral infection, parasites, gallstones, tumors, or most commonly from a calcified “stone” made of fecal matter. That can lead to increased pressure, decreased blood flow, and bacterial growth inside the appendix causing inflammation.
That inflammation, known as appendicitis, can have dire consequences if not properly treated. In addition to abdominal pain, nausea, vomiting, and fever, an untreated appendix will eventually burst, spilling infectious materials into the abdominal cavity.
That can lead to a septicemia, which is a serious blood infection, or peritonitis, which is a severe inflammation of the intestinal lining. A cascade of problematic reactions can follow which can ultimately end in septic shock, severely low blood pressure, multiple organ failure and, in the worst-case scenario, death.
For those reasons, it’s critical that problems with the appendix be identified and treated as early as possible. For decades, the standard procedure for treating appendicitis has been an appendectomy, which is the complete surgical removal of the appendix.
Surgical treatment for appendicitis began when surgery itself was a relatively new idea, back in the 1880s. It was difficult at the time for doctors to choose which patients to operate on because surgery itself was risky and some patients would recover from their condition without it.
But as surgical knowledge and technology improved and reliable and effective anesthesia was introduced, the risks associated with performing surgery grew smaller and smaller. Eventually, the appendectomy became the standard course of action.
Doctors tend to favor appendectomies for two main reasons. First, they want to address the problem as quickly as possible before the appendix bursts to eliminate the risk of the more serious, life-threatening infection that can result if left untreated.
Second, a person doesn’t need their appendix to live, technically speaking. People who have their appendix removed seem to have no significant long term health effects as a result, though they may have a slightly increased risk for some conditions like Crohn’s disease.
However, there are potential downsides to appendectomy as a treatment for appendicitis. There is a risk of infection at the site of the surgical incision. Those infections can be quite mild, with only some redness and tenderness as symptoms, to severe, requiring antibiotics and further surgery.
There is also the possibility that an appendectomy can lead to the formation of an abscess, which is a collection of pus in the area of the appendix or pelvis. Though the risks of those complications or the thought of surgery can be scary, many people believe that appendectomy is the only option they have.
However, research in recent years has shown that there is a non-surgical option when dealing with appendicitis. When appendicitis is “uncomplicated,” meaning that the appendix has not yet ruptured, it is possible to treat it using only antibiotics.
A recent study performed at Turku University Hospital in Finland took 530 patients with uncomplicated appendicitis and split them into two groups. One group received antibiotic treatment while the other had appendectomies. They then followed both groups for one year.
In the end, 72 percent of the group that received antibiotics didn’t require removal of their appendixes. Other studies over the last two decades have shown similar results, suggesting that the appendectomy may not necessarily need to be the first choice for treatment.
Many Get Better
This is especially compelling when you consider that the appendix bursts in only 15 to 25 percent of cases of appendicitis. For all other people, appendicitis eventually goes away on its own, though they will still suffer the unpleasant symptoms in the interim.
People treated only with antibiotics also required fewer doses of painkillers, which is an important factor to consider in the midst of the opioid epidemic. Those patients were also able to return to work faster than people who underwent surgery.
In further support of antibiotic treatment, it is also significantly less expensive than surgery, and results in 31 percent fewer complications, according to a recent study. However, there are still some advantages to the surgical option.
Not All Positives
The biggest one is that an antibiotic treatment may not be a permanent solution. In about 20 percent of cases, patients can suffer from appendicitis again within a year. And of those 20 percent, one in five of them suffer from a burst appendix and the associated complications.
Talk to Your Doctor
Ultimately, the decision to have an appendectomy or take an antibiotic-only approach should be made during a conversation with your doctor. If you believe you may be suffering from appendicitis, seek medical help as soon as possible.