Appendectomy: Not Mandatory in all Cases of Appendicitis

Unoperated appendicitis is not a death warrant. A recent editorial in JAMA provides some interesting evidence going back to the origins of modern surgery.[1] A very nice RCT is reported in the same issue of JAMA.[2] It shows no long-term health risks in the conservatively managed group, but over a quarter in the non-surgical group had an interval operation for ongoing symptoms. However, here is the risk – a point mentioned by neither the editorialist nor trial authors. The cases entered in the study were all carefully selected by CT scan. But in most parts of the world emergency CT scanning is not available. So it would not be possible to apply the many exclusions, including a plug of material, called an appendicolith, in the lumen of the appendix. So while these are important studies in high-income countries, it would be very hard, and arguably risky, to generalise to other countries.

— Richard Lilford, CLAHRC WM Director


  1. Livingstone E, Vons C. Treating Appendicitis Without Surgery. JAMA. 2015;313(23):2327-8.
  2. Salminen P, Paajanen H, Rautio T, et al. Antibiotic Therapy vs. Appendectomy for Treatment of Uncomplicated Acute Appendicitis. The APPAC Randomized Controlled Trial. JAMA. 2015; 313(23):2340-8.

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