LETTER TO THE EDITOR: Non Surgical Management of Acute Appendicitis

Abstract

Appendectomy for acute appendicitis in emergency 1 is universally accepted and effective procedure.Only in United States more than 300,000 appendicectomy are performed annually. Statistically, the life-time risk to have acute appendicitis is 8.6% in men and 6.7% in women but the risk for emergency appendectomy is 12% and 23%, respectively. Pathologically, acute appendicitis progresses invariably from mild inflammation to gangrene and perforation and as a treatment the 2 emergency appendectomy is always required. The non-operative management of uncomplicated acute salpingitis, cholecystitis and diverticulitis has been
well established but the non-operative management 3 of acute appendicitis remains controversial. Some centers or surgeons use preoperative antibiotic totreat acute appendicitis in selected cases for delaying an appendectomy, particularly during twilight hours. In these cases the incidence of perforation, other complications and hospital stay especially in children operated within 6 h is equivalent to those who underwent emergency appendicectomy between 6 and 18 h after 2 admission. Literature review conclude that although antibiotics may be used as the primary treatment in acute appendicitis in selected cases, but this is
treatment option is less likely to supersede 2,4 appendectomy as a definitive treatment modality. There are only one Cochrane analysis, five metaanalysis and some review article were found after extensive literature search about non-operative treatment of acute appendicitis. All these studies concludes that non operative treatment may reduce the post operative complications rate but the lower efficacy of treatment is the main concern which prevent the surgeons to adopt antibiotic therapy  from being a first-hand alternative to surgery. On the other hand, appendectomy may not be always necessary for the patients with uncomplicated acute appendicitis as many patients resolve spontaneously or with antibiotic therapy. Six randomized controlled trials (RCTs) have compared the efficacy of antibiotic therapy with surgery in the treatment of acute 2 appendicitis. A recent meta-analysis by Mason et al reported that the conservative management of uncomplicated acute appendicitis is associated with significantly fewer complications, better pain control.