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Appendectomy versus Antibiotic Treatment in Acute Appendicitis. A Prospective Multicenter Randomized Controlled Trial

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Abstract

Background

Appendectomy has been the treatment for acute appendicitis for over 120 years. Antibiotic treatment has occasionally been used in small uncontrolled studies, instead of operation, but this alternative has never before been tried in a multicenter randomized trial.

Patients and Methods

Male patients, 18–50 years of age, admitted to six different hospitals in Sweden between 1996 and 1999 were enrolled in the study. No women were enrolled by decision of the local ethics committee. If appendectomy was planned, patients were asked to participate, and those who agreed were randomized either to surgery or to antibiotic therapy. Patients randomized to surgery were operated on with open surgery or laparoscopically. Those randomized to antibiotic therapy were treated intravenously for 2 days, followed by oral treatment for 10 days. If symptoms did not resolve within 24 hours, an appendectomy was performed. Participants were monitored at the end of 1 week, 6 weeks, and 1 year.

Results

During the study period 252 men participated, 124 in the surgery group and 128 in the antibiotic group. The frequency of appendicitis was 97% in the surgery group and 5% had a perforated appendix. The complication rate was 14% in the surgery group. In the antibiotic group 86% improved without surgery; 18 patients were operated on within 24 hours, and the diagnosis of acute appendicitis was confirmed in all but one patient, and he was suffering from terminal ileitis. There were seven patients (5%) with a perforated appendix in this group. The rate of recurrence of symptoms of appendicitis among the 111 patients treated with antibiotics was 14% during the 1-year follow-up.

Conclusions

Acute nonperforated appendicitis can be treated successfully with antibiotics. However, there is a risk of recurrence in cases of acute appendicitis, and this risk should be compared with the risk of complications after appendectomy.

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Acknowledgments

This work was supported by research funds of the Swedish Society of Medicine, Karolinska Institutet; the Wallenius Corporation; Aventis Pharma (former Hoecht Marion Roussel). We are indebted to G. Orrebrink and O. Ståhlebrandt for their contributions to this study.

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Author notes

  1. Staffan Eriksson MD, PhD

    Present address: Department of Surgery, Västerås Hospital, S-721 89, Västerås, Sweden

Authors and Affiliations

  1. Department of Surgery, Karolinska Institutet at Danderyd Hospital, S-182 88, Stockholm, Sweden

    Johan Styrud MD, PhD, Staffan Eriksson MD, PhD & Lars Granström MD, PhD

  2. Department of Surgery, St Göran Hospital, Karolinska Institutet, S-171 77, Stockholm, Sweden

    Ingemar Nilsson MD, PhD & Gunnar Ahlberg MD, PhD

  3. Department of Surgery, Norrköping Hospital, S-60182, Norrköping, Sweden

    Staffan Haapaniemi MD, PhD

  4. Department of Surgery, Kristianstad Central Hospital, S-29185, Kristianstad, Sweden

    Gunnar Neovius MD

  5. Department of Surgery, Borås Hospital, S-50182, Borås, Sweden

    Lars Rex MD

  6. Department of Surgery, Katrineholm Hospital, S-64122, Katrineholm, Sweden

    Ibrahim Badume MD

Authors
  1. Johan Styrud MD, PhD
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  2. Staffan Eriksson MD, PhD
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  3. Ingemar Nilsson MD, PhD
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  4. Gunnar Ahlberg MD, PhD
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  5. Staffan Haapaniemi MD, PhD
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  6. Gunnar Neovius MD
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  7. Lars Rex MD
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  8. Ibrahim Badume MD
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  9. Lars Granström MD, PhD
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Corresponding author

Correspondence to Johan Styrud MD, PhD.

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Styrud, J., Eriksson, S., Nilsson, I. et al. Appendectomy versus Antibiotic Treatment in Acute Appendicitis. A Prospective Multicenter Randomized Controlled Trial. World J. Surg. 30, 1033–1037 (2006). https://doi.org/10.1007/s00268-005-0304-6

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  • DOI: https://doi.org/10.1007/s00268-005-0304-6

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