Nonoperative Management of Appendicitis Safe Over Long Term

FRIDAY, Aug. 11, 2023 (HealthDay News) -- More than half of patients treated nonoperatively for acute appendicitis did not experience recurrence and avoided surgery over two decades of follow-up, according to a research letter published online Aug. 9 in JAMA Surgery.

Barbora Pátková, M.D., from the Karolinska Institute in Stockholm, and colleagues sought to report long-term outcomes (19 to 26 years) among participants in the first two randomized clinical trials comparing appendectomy to nonoperative treatment for appendicitis. Among 292 combined participants, 259 were traceable in the Swedish National Patient Registry through the follow-up period (appendectomy, 122 patients; nonoperative treatment, 137 patients). Both trials were conducted in Sweden in the 1990s.

The researchers found that by 25 years of follow-up, 21 participants (15 percent) had appendectomy due to failure of nonoperative treatment at initial hospital admission and 34 (29 percent) had a subsequent appendectomy for acute appendicitis so that 82 of 137 patients (60 percent) had not undergone appendectomy at the end of follow-up. Overall, 82 of 116 participants (71 percent) who had been successfully discharged without appendectomy remained without appendectomy. In the nonoperative group, in addition to the subsequent appendectomies, 13 of 137 patients (9.5 percent) visited a surgical outpatient clinic for abdominal pain versus one of 122 patients (0.01 percent) from the appendectomy group. No patient in either group underwent surgery for bowel obstruction during follow-up, and among patients treated nonoperatively, no appendiceal tumors were reported during follow-up.

"There is no evidence for long-term risks of nonoperative management other than that of recurrence of appendicitis," the authors write.

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