When it comes to uncomplicated appendicitis, it’s getting complicated

Abstract

In recent years, nonoperative management (NOM) of uncomplicated acute appendicitis (UAA) has garnered increasing attention and favor as a safe, noninferior clinical strategy for both adults and children. Although avoiding a potentially unnecessary operation may sound appealing at first glance, the best data from large trials of NOM show that the success rate at 1 year is 66%. 1 Minneci P.C. Hade E.M. Lawrence A.E. Association of nonoperative management using antibiotic therapy vs laparoscopic appendectomy with treatment success and disability days in children with uncomplicated appendicitis. JAMA. 2020; 324: 581-593 Crossref PubMed Scopus (24) Google Scholar Data from others studies in children and adults demonstrate similar outcomes. In a recent study in which nearly 200 patients underwent randomization between operative and nonoperative intervention, the authors demonstrated that patients with acute, uncomplicated appendicitis treated with antibiotics experience high recurrence rates (25.3%) and an inferior quality of life and recommended that surgery should remain the mainstay of treatment for this commonly encountered acute surgical condition. 2 O’Leary D.P. Walsh S.M. Bolger J. A randomised clinical trial evaluating the efficacy and quality of life of antibiotic only treatment of acute uncomplicated appendicitis: results of the COMMA trial [E-pub ahead of print]. Ann Surg. 2021; (Accessed May 13, 2021)https://doi.org/10.1097/SLA.0000000000004785 Crossref PubMed Scopus (1) Google Scholar The literature has become saturated with debates about the avoidance of acute surgical intervention, but the data are minimally reassuring for many surgeons and potentially confusing when counseling patients and parents regarding risks and benefits of long-term outcomes and antibiotic use.