Interval Appendicectomy Redundant in Majority of Cases

A new study finds that only 12% of patients with an appendix mass develop recurrent appendicitis that requires surgical intervention, following initial antibiotic treatment.

Researchers at the University of Southampton, the Hospital for Sick Children, and Southampton Children's Hospital conducted an open-label, randomized study at 19 specialist pediatric surgery centers in the UK, Sweden, and New Zealand. In all, 106 children (3–15 years of age) diagnosed with acute appendicitis with an appendix mass were assigned to interval appendicectomy or active observation.

“After successful non-operative treatment, present surgical dogma is that interval appendicectomy should be done to avoid future recurrence of acute appendicitis,” said lead author consultant pediatric surgeon Nigel Hall, MD, of Southampton Children's Hospital. “Adoption of a wait-and-see approach, reserving appendicectomy for those who develop recurrence or recurrent symptoms, results in fewer days in hospital, fewer days away from normal daily activity and is cheaper than routine interval appendicectomy.”

“This study will allow clinicians, parents and children to make an evidence-based decision regarding the justification for interval appendicectomy and, in many cases, remove the need for surgery completely,” concluded Dr. Hall. “A systematic review of retrospective studies suggested the incidence of recurrent appendicitis was approximately 20%, but we have shown that figure is much lower. This calls into question the justification for surgery as standard practice.”

Appendectomy is the surgical removal of the vermiform appendix. The procedure is normally performed as an emergency procedure, when the patient is suffering from acute appendicitis. In the absence of surgical facilities, intravenous antibiotics are used to delay or avoid the onset of sepsis. In some cases the appendicitis resolves completely; more often, an inflammatory mass forms around the appendix, causing transruptural flotation.