Appendicitis Treatment Options

What is Appendicitis?

Appendicitis is a common swelling of the appendix, a finger-sized tube attached to the large intestine. The swelling is caused by an infection which is painful and may make you feel sick.

How Is Appendicitis Treated?

Most patients in the United States have surgery called an appendectomy to take out the appendix. But six European studies show that most people with appendicitis can be treated successfully with medicines called antibiotics instead of having to get surgery. 

Although studies show that both treatments are safe and effective, no one knows for sure which is better: surgery to take out the appendix, or medicine to treat the infection. We are doing a study to try to figure that out.

Appendectomy

Surgery to take out the appendix is called an appendectomy. Most times, an appendectomy is done with three or four tiny incisions, or cuts, on the belly. This is called laparoscopic surgery. Sometimes, surgery is done with a single, larger incision. This is called open surgery.

During surgery, the appendix is removed from the body. Then the cuts on the belly are closed with staples or stitches.

After surgery, most patients go home by the next day. Some stay in the hospital for an extra day or longer. Most patients are sent home with pain medicine to take as needed and return to normal activities after about 1 week. 

What Are The Benefits?

Surgery removes the cause of the infection. After the appendix is removed, patients do not get appendicitis again.

What Are The Risks?

About 1 out of 10 patients has a problem after surgery. Most of these problems are minor, such as a skin infection where the incisions were made. 

Serious risks after surgery include infections or bleeding inside the belly, or, vary rarely, leaking from the intestine where the appendix was attached. These more serious problems do not happen very often. If they do happen, another surgery might be needed to fix them.

Antibiotics

Antibiotics are medicines that fight infection. If appendicitis is treated with antibiotics and the patient feels well enough to go home from the emergency room, they might not have to stay in the hospital at all. Or, they may stay in the hospital for a day or two depending on how they feel.

First, the antibiotics are given through a small plastic tube in the vein. This tube is called an IV. While the patient is getting antibiotics, they may also get medicines to treat pain and nausea.

Once the patient goes home, they will have to keep taking antibiotic pills for a total of 10 days. It’s important that they take the full 10 days of antibiotics, even if they feel better. They will also be given pain medicine to take home with them, that they can take as needed.

What Are The Benefits?

If antibiotics work, the patient will not need to have surgery. They may be able to return to work or school faster and have less pain and problems than if they have surgery. They may also be able to go home from the emergency room if they are feeling better, instead of having to stay overnight in the hospital.

Results from six studies tell us that antibiotics are a safe way to treat appendicitis. In these studies, patients who were successfully treated with antibiotics were contacted 1 year after their first hospital visit. About 3 out of 4 patients did not have any more problems with their appendix.

The studies also show that patients have good results up to 1 year after their first hospital visit, both after surgery and after taking antibiotics.

What Are The Risks?

The most common risks of antibiotics are upset stomach, diarrhea, and skin rashes. Serious problems from taking antibiotics are very rare.

About 1 out of 4 may have more problems with their appendix and need to have surgery later. Some will need surgery shortly after the antibiotics because they are not improving. Others may get appendicitis again months or years later.