MODERN VIEWS FOR THE TREATMENT OF ACUTE UNCOMPLICATED APPENDICITIS: APPENDECTOMY OR ANTIBIOTICS?

  • V.V. Vashchuk
  • V.P. Andrushchenko
  • T.V. Khomchenko
  • T.P. Kyryk
Keywords: acute uncomplicated appendicitis, antibiotics, appendectomy, meta-analysis

Abstract

Summary. The paper reviews the results of randomized controlled trials and meta-analysis data from comparisons of antibiotics and appendectomy in the treatment of acute uncomplicated appendicitis ) is carried. It has been shown that appendectomy remains in most cases the gold standard for the treatment of acute uncomplicated appendicitis is proved. At the same time, it is noted that in separate groups of patients with no risk of development of complications and / or with high operational risk in persons with critical violations of vital functions of the body, in case of impossibility to perform an operation, antibiotic therapy can be a highly effective and safe method of treatment is established. Preparations of choice are carbapenems (mepenes), fluoroquinolones III (levofloxacin) and metronidazos/ornizol is indicated.

References

Acute appendicitis: Epidemiology, treatment and outcomes- analysis of 16544 consecutive cases/ M. Ceresoli, A. Zucchi, N. Allievi, [et al.]// World J Gastrointest. Surg.-2016;8(10):693-699.

Acute uncomplicated appendicitis study: rationale and protocol for a multicentre, prospective randomised controlled non-inferiority study to evaluate the safety and effectiveness of non-operative management in children with acute uncomplicated appendicitis/ J. Xu, Y.C. Liu, S. Adams [et al.]// BMJ Open.-2016;6(12):e013299.

Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: An open-label, non-inferiority, randomised controlled trial/ C. Vons, C. Barry, S.Maitre [et al.]// Lancet.-2011;377:1573–1579.

Antibiotics alone versus appendectomy to treat uncomplicated acute appendicitis in adults: What do meta-analyses say?/ L.L. Rocha, F.M. Rossi, C.M. Pessoa [et al.]// World J Emerg. Surg.- 2015;10:51.

Antibiotic versus appendicectomy for the treatment of uncomplicated acute appendicitis: An updated meta-analysis of randomised controlled trials/ K.E. Rollins, K.K.Varadhan, K.R. Neal [et al.]//World J Surg.-2016;40: 2305–2318.

Antibiotics-first strategy for uncomplicated acute appendicitis in adults is associated with increased rates of peritonitis at surgery. A systematic review with meta-analysis of randomized controlled trials comparing appendectomy and non-operative management with antibiotics/ M. Podda, N. Cillara, S. Di Saverio [et al] ACOI (Italian Society of Hospital Surgeons) Study Group on Acute Appendicitis//Surgeon.-2017: S1479-666X(17)30056-2 [Epub ahead of print]

Antibiotics-first versus surgery for appendicitis: A US pilot randomized controlled trial allowing outpatient antibiotic management/ D.A. Talan, D.J. Saltzman, G.J. Mower [et al.]// Ann. Emerg. Med.-2016 [Epub ahead of print]. doi: 10.1016/j annemergmed 2016.08.446.

Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: The APPAC randomized clinical trial/ P. Salminen, H. Paajdnen, T.Rautio [et al.] //JAMA.- 2015;313:2340–2348.

Antibiotic therapy versus appendectomy for acute appendicitis: A meta-analysis/ K.K.Varadhan, D.J. Hmumes, K.R. Neal [et al.] //World J Surg.-2010;34:199–209.

Antibiotics vs. Appendectomy for Acute Uncomplicated Appendicitis in Adults: Review of the Evidence and Future Directions/ J.M. Huston, L.S. Kao, Ph.K. Chang [et al.]//Surg. Infect.- 2017;18(5):527-535.

Antibiotics versus surgical therapy for uncomplicated appendicitis: Systematic review and meta-analysis of controlled trials (PROSPERO 2015: CRD42015016882)/ J.C. Harnoss, J. Zelienkap, P. Probst [et al.]// Ann. Surg.-2017; 265:889–900.

Appendicectomy for suspected uncomplicated appendicitis is associated with fewer complications than conservative antibiotic management: meta-analysis of post-intervention complications/ A. Kirby, R.P. Hobson, D.Burke [et al.]// J Infect.-2015;70:105–110.

Appendectomy as a Risk Factor for Bacteremic Biliary Tract Infection Caused by Antibiotic-Resistant Pathogens/ K. Kawanishi , J. Kinoshita , H. Abe [et al.]// Biomed. Res. Int.-2017; 2017:3276120.

Appendectomy versus antibiotic treatment for acute appendicitis/ I.M. Wilms, D.E. de Hogg, D.C. de Visser [et al.]// Cochrane Database Syst Rev 2011(11):CD008359. doi: 10.1002/14651858.CD008359.pub2.

Appendectomy versus antibiotic treatment in acute appendicitis. A prospective multicenter randomized controlled trial/ J. Styrud, S. Eriksson, I. Nilsson [et al.]// World J Surg.-2006; 30: 1033–1037.

A prospective randomized controlled multicenter trial comparing antibiotic therapy with appendectomy in the treatment of uncomplicated acute appendicitis (APPAC trial)/ H. Paajanen, J.M. Grönroos , T. Rautio [et al.] //BMC Surg.-2013;13:3.

Boshnak N. Evaluation of Platelet Indices and Red Cell Distribution Width as New Biomarkers for the Diagnosis of Acute Appendicitis/ N. Boshnak, M. Boshnaq, H. Elgohary// J Invest Surg.-2017:1-9. [Epub ahead of print]

Coldrey E. Five years of conservative treatment of appendicitis/ E.Coldrey //J Int. Coll. Surg.-1959;32:255–261.

Comparison of Antibiotic Therapy and Appendectomy for Acute Uncomplicated Appendicitis in Children A Meta-analysis/L. Huang, Y. Yin, L.Yang [et al.]//JAMA Pediatr.-2017; 171(5):426-434.

Conservative Treatment Versus Appendectomy for Acute Uncomplicated Appendicitis/ E. Hokkam, A. Gonna, A. Saber [et al.] //J Surg.- 2016; 4(2-1): 27-30.

Cost effectiveness of nonoperative management versus laparoscopic appendectomy for acute uncomplicated appendicitis/ J.X. Wu, A.J. Dawes, G.D. Sacks [et al.]//Surgery.- 2015;158:712–721.

Debnath J. Imaging in acute appendicitis: What, when, and why?/ J Debnath, R.A. George, R. Ravikumar// Med. J Armed Forces India.-2017;73(1):74-79.

Diagnostic value of procalcitonin for acute complicated appendicitis/ H Yamashita, N. Yuasa, E. Takeuchi [et al.]// Nagoya J Med. Sci.-2016;78(1):79-88.

Effectiveness of patient choice in nonoperative vs surgical management of pediatric uncomplicated acute appendicitis/ P.C. Minneci, J.B. Mahida, D.L. Lodwick [et al.]//JAMA Surg.-2016;151:408–415.

Eriksson S. Randomized controlled trial of appendicectomy versus antibiotic treatment therapy for acute appendicitis/ S. Eriksson, L Granstrom //Br. J Surg.-1995; 82: 166–169.

Liu K. Use of antibiotics alone for treatment of uncomplicated acute appendicitis: A systematic review and meta-analysis/ K. Liu, L.Fogg// Surgery.-2011;150 (4):673–683.

Livingston E. Treating appendicitis without surgery/ E Livingston, C.Vons//JAMA.- 2015;313:2327–2328.

Malik A.A. Conservative management of acute appendicitis/A.A. Malik, S.U. Bari // J Gastrointest. Surg.-2009;13: 966–970.

Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis/ V. Sallinen, E.A. Akl, J.J. You [et al.]// Br J Surg.-2016;103:656–667.

Meta-analysis of the therapeutic effects of antibiotic versus appendicectomy for the treatment of acute appendicitis/ Z.H. Liu, C. Li, W. Zhang [et al.] Exp. Ther. Med.- 2014;7: 1181–1186.

Metaanalysis of randomized trials comparing antibiotic therapy with appendectomy for acute uncomplicated (no abscess or phlegmon) appendicitis/ R.J. Mason, A. Mouzzeza, J.R. Moroney [et al.]//Surg Infect.-2012;13:74–84.

Nonoperative management of appendicitis in adults: A systematic review and meta-analysis of randomized controlled trials/ J.M. Findlay, J.E. Kufsi, C. Hammer [et al.]//J Am. Coll. Surg.- 2016;223:814–824.

Nonoperative treatment of acute appendicitis in children: A feasibility study/ J. Hartwich, F.I. Luks, D. Watson-Smith [et al.]// J Pediatr. Surg.-2016;51(1):111-6.

On the Role of Ultrasonography and CT Scan in the Diagnosis of Acute Appendicitis/J. Debnath, R. Kumar, A. Mathur [et al.]// Indian J Surg.- 2015;77(2):221-6.

Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients/ J. Hansson, U. Korner, A. Khorram-Manesh [et al.]//Br J Surg.-2009; 96: 473–481.

Surgery versus conservative antibiotic treatment in acute appendicitis: A systematic review and meta-analysis of randomized controlled trials/ L. Ansaloni, F. Catena, F. Coccolini [et al.] Dig. Surg.- 2011;28:210–221.

The cost-effectiveness of nonoperative management versus laparoscopic appendectomy for the treatment of acute, uncomplicated appendicitis in children/ J.X. Wu, A.J. Sacks, G.D. Sacks [et al.]//J Pediatr. Surg.-2016 DOI 10.1016/j surg.- 2015;06.021

The NOTA Study (Non Operative Treatment for Acute Appendicitis): prospective study on the efficacy and safety of antibiotics (amoxicillin and clavulanic acid) for treating patients with right lower quadrant abdominal pain and long-term follow-up of conservatively treated suspected appendicitis// S. Di Saverio, A. Sibilio, E. Giorgini [et al.]// Ann. Surg.-2014;260(1):109-17.

The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection/ J.E. Mazuski, J.M. Tessier, A.K. May[ et al.]// Surg. Infect.- 2017;18:1–76.

Varadhan K.K. Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: Meta-analysis of randomised controlled trials/ K.K. Varadhan, K.R. Neal, D.N.Lobo // BMJ .-2012;344:e2156.

Wojciechowicz K.H. Conservative treatment of acute appendicitis: An overview/K.H. Wojciechowicz, H.J. Hoffkamp, R.A. van Hulst // Int.Marit. Health.- 2010;62:265–272.

Yuan F. Retrospective audit of patients presenting for ultrasound with suspicion of appendicitis/ F. Yuan, M. Necas// Australas. J Ultrasound Med.-2015;18(2):67-69.

Published
2019-12-25
How to Cite
Vashchuk , V., Andrushchenko , V., Khomchenko , T., & Kyryk , T. (2019). MODERN VIEWS FOR THE TREATMENT OF ACUTE UNCOMPLICATED APPENDICITIS: APPENDECTOMY OR ANTIBIOTICS?. Kharkiv Surgical School, (5-6), 86-94. https://doi.org/10.37699/2308-7005.5-6.2019.19
Section
NOTES OF MEDICAL PRACTITIONER