What Is the Role of Conservative Antibiotic Treatment in Early Appendicitis?

Abstract

Acute appendicitis remains a common surgical condition and appendicectomy remains the mainstay of treatment for over 130 years. The first appendicectomy was performed by A. Groves more than a century ago. Following the publication of R. Fitz’s classical (1) paper in 1886 on 247 patients with perforated appendicitis, early appendicectomy has been advocated as the standard treatment for early appendicitis. Later, in 1889 McBurney (1) published his study of eight patients with acute appendicitis and further recommended early appendicectomy as optimal management. Since then early appendicectomy has been widely accepted as the best treatment for early appendicitis. (1, 2). However, as the diagnosis of acute appendicitis remains largely a clinical one, diagnostic uncertainty may lead to a delay in treatment or negative surgical exploration, both adding to the morbidity associated with this condition. While antibiotics are indicated in patients with signs of peritonism, their current role in the routine management of early acute nonperforated appendicitis remains debatable. Over the past two decades, three randomised controlled trials have been published comparing the efficacy of antibiotics alone with that of surgery for selected and unselected patients with that of surgery for acute appendicitis (3, 4, and 5). It is the aim of this chapter to give a critical analysis of the existing data regarding the non-surgical management of acute appendicitis with special reference to the efficacy, long-term outcome and the selection of patients for conservative treatment.