Conservative treatment for uncomplicated acute appendicitis in adults

Abstract

Background: Acute appendicitis is a very common disease with a life time risk of approximately 7-8%. Worldwide, the standard of care for appendicitis is appendectomy that is to date considered generally a “routine and safe operation”. However, the mortality rate of appendectomy is 0.7% and 2.4% in patients without and with perforation, respectively. Aim: The paper aims to investigate the debate on surgical and non surgical treatment of acute uncomplicated appendicitis. Methods: Pubmed and embase were queried for “acute appendicitis, antibiotics, surgery, conservative treatment, diagnosis”. All prospective randomized studies, meta-analysis, systematic reviews and significant retrospective studies were retrieved. A brief analysis of single RCT and meta-analysis was conducted. Finally, the topic was developed by focusing on several clinical aspects. Discussion and conclusions: The comparison of surgery and antibiotics, in terms of efficacy to treat acute appendicitis, is intrinsically complex due to the huge disparity of management and treatment options. After establishing an institutional validated clinical score, uncomplicated appendicitis in adult can be safely and successfully treated by antibiotic therapy an in-hospital setting if the patient is well informed. Nevertheless, outpatient antibiotic treatment cannot be proposed as a routine clinical practice. High risk patients should be treated with antibiotics whilst any treatment failure should be considered for mandatory surgery.