Surgeons Often Excise Useful Appendix Even When Antibiotics Would Have Cured–“Surgeons Who Don’t Operate Miss Out on a Hefty Fee”

(p. D7) The appendix is a finger-shaped pouch attached to the large intestine (colon), usually on the lower right side of the abdomen. Long considered a vestigial organ with no known function, many people, young and old, have theirs removed in the course of another operation.

However, there are now indications that the appendix serves as a repository of healthy bacteria that can replenish the gut after an extreme attack of diarrhea. People who have had appendectomies, for example, are more likely to experience recurrent infections with the bacterium Clostridium difficile, a debilitating intestinal infection that causes severe, difficult-to-treat diarrhea.

. . .

Acute appendicitis is the nation’s most common surgical emergency.  . . .  Some 300,000 people in the United States undergo an appendectomy each year, but sometimes, the appendix turns out not to have been inflamed, meaning the operation was not necessary.

The results of several recent studies suggest that patients with uncomplicated appendicitis should not be rushed into surgery and instead should be offered the option of a trial of antibiotics.

In a controlled study among 540 adult patients, 72.7 percent of 257 patients randomly assigned to take antibiotics in lieu of an operation did not require subsequent surgery a year later, and those who did need surgery had no bad effects from the delay.

In another nonrandomized study of 3,236 patients who were not operated on initially, the nonsurgical treatment failed to cure the appendicitis in 5.9 percent of cases, and the inflammation recurred in 4.4 percent.

Some patients may choose an operation so they won’t have to worry about developing another attack of appendicitis, but if they aren’t told they have a choice, they can hardly make one.

Writing in JAMA [in February 2016] . . ., Dr. Dana A. Telem, a surgeon at Stony Brook University Medical Center, noted that “the notion of nonoperative treatment of appendicitis has not been well-received by the majority of the surgical community.” This is hardly surprising, because doctors, like many of us, are creatures of habit, and surgeons who don’t operate miss out on a hefty fee.

For the full story see:

JANE E. BRODY. “PERSONAL HEALTH; A Choice for Treating Appendicitis.” The New York Times (Tuesday, March 22, 2016 [sic]): D7.

(Note: ellipses, and bracketed words, added.)

(Note: the online version of the story has the date March 21, 2016 [sic], and has the title “PERSONAL HEALTH; A New View of Appendicitis.”)

The controlled randomized study mentioned above is:

Salminen, Paulina, Hannu Paajanen, Tero Rautio, Pia Nordström, Markku Aarnio, Tuomo Rantanen, Risto Tuominen, Saija Hurme, Johanna Virtanen, Jukka-Pekka Mecklin, Juhani Sand, Airi Jartti, Irina Rinta-Kiikka, and Juha M. Grönroos. “Antibiotic Therapy Vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The Appac Randomized Clinical Trial.” JAMA 313, no. 23 (2015): 2340-48.

The nonrandomized study mentioned above is:

McCutcheon, Brandom A., David C. Chang, Logan P. Marcus, Tazo Inui, Abraham Noorbakhsh, Craig Schallhorn, Ralitza Parina, Francesca R. Salazar, and Mark A. Talamini. “Long-Term Outcomes of Patients with Nonsurgically Managed Uncomplicated Appendicitis.” Journal of the American College of Surgeons 218, no. 5 (May 2014): 905-13.

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