Thousands of patients could avoid ‘needless’ appendix operations

Thousands of patients could avoid ‘needless’ appendix removals if they are given strong antibiotics instead

  • Treating ‘uncomplicated’ appendicitis with drugs could be a safer alternative
  • Six in 10 people who are given medication do not need follow-up surgery 
  • Surgery could cause health issues which would be avoided with antibiotics
  • Around 40,000 people go to hospital with appendicitis every year in the UK 
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Thousands of patients could be spared unnecessary surgery for appendicitis each year if they are given antibiotics instead, a study found.

Treating cases of ‘uncomplicated’ appendicitis with strong antibiotics was found to be a safe alternative to appendectomies.

Researchers found more than six in 10 patients who were first treated with antibiotics had not had their appendix removed five years later.

Even many of the patients who had undergone surgery may not have needed to, scientists suggest, and they tended to be more unwell in the long run.

Treating patients with drugs instead would save lives, aid patient recovery and reduce costs to the NHS, they said.

Treating appendicitis patients with strong antibiotics instead of operating to remove the organ could save the health service money and improve recovery times for thousands of patients, according to researchers at Turku University Hospital in Finland

Uncomplicated appendicitis – where the appendix is inflamed but has not led to perforation of the organ or a serious infection – accounts for 80 per cent of cases.

The other 20 per cent are deemed complicated and surgery remains the only option, researchers from Turku University Hospital in Finland say.

Yet most doctors wrongly believe that removing the organ is the only option, a notion dating back to the 18th century.

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During the Cold War, American sailors on nuclear submarines who developed appendicitis were initially treated with antibiotics before surgery at a later date if it was required, which it often wasn’t.

Finnish researchers wanted to test the effectiveness of antibiotics compared to surgery once uncomplicated appendicitis had been diagnosed.

The original study involved 530 patients, aged between 18-60, and diagnosed with acute uncomplicated appendicitis following a CT scan.

Antibiotics were given to 257 patients while the remaining 273 had surgery to remove their appendix.

They were given the strong antibiotic, ertapenem, intravenously for three days followed by two antibiotic tablets for a week.

After a year, more than three-quarters – 78 per cent – of those treated with antibiotics did not require surgery.

Of those treated with antibiotics, 27 per cent suffered relapses within a year, rising to 39 per cent after five years.


Appendicitis is a swelling of the appendix, a two to four-inch-long organ connected to the large intestine.

Appendicitis can cause severe pain and it’s important for it to be treated swiftly in case the appendix bursts, which can cause life-threatening illness.

In most cases surgeons will remove the appendix in an appendectomy – scientists aren’t sure why people need an appendix but removing it does not harm people.

The causes of appendicitis aren’t clear but it is thought to be caused by something blocking the entrance to the organ.

Symptoms include pain in the stomach which later travels to your lower right-hand-side and becomes severe. 

Pressing on this area, coughing, or walking can all make the pain worse, and other symptoms can be nausea, vomiting, loss of appetite, diarrhoea and a fever.

Source: NHS 

In total, 70 patients underwent an appendectomy in the first year and a further 30 within the next five years.

But of these, only two were found to have complicated appendicitis, again suggesting surgery may not have been necessary.

Of those who did go onto have surgery, none suffered serious complications from delays to having the appendix removed, they found.

Dr Paulina Salminen, who led the study, said the findings show antibiotics is an effective first line of treatment to treat uncomplicated appendicitis.

She said: ‘It is a viable safe option and alternative to surgery and that is something that really should be considered by the surgical community, the physicians and also patients.

‘If the majority of uncomplicated acute appendicitis cases can be treated with antibiotics alone, then we would avoid unnecessary surgery and the associated morbidity to that surgery.

‘Even though the surgery is routine, with every routine surgery you still have the surgical complications – infections, incisional hernia, and abdominal pain after the procedure.

‘In our study after the five year results, the morbidity was much higher in the operative group.

‘The recovery period is obviously much shorter after antibiotic therapy and would save operative resources and healthcare costs.’ 

NHS figures show that around 40,000 patients are admitted to hospital with appendicitis every year.

In most cases, the appendix is surgically removed ‘as soon as possible’, making it one of the most common operations in the UK.

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