Tuesday, April 4, 2017

Non Operative Treatment of Appendicitis

R.E.E.B.E.L.EM - April 3, 2017 - Post Peer Reviewed By: Matt Astin
"Background: Historically the treatment of uncomplicated appendicitis has been appendectomy. The first appendectomy performed dates back to 1735 done by Claudius Amyand. Appendectomy has been the standard treatment for acute appendicitis every since Charles McBurney described it in 1889. However, studies have shown that an antibiotic first strategy may be feasible without increased risk of perforation, sepsis, and/or death. This other approach is called NOTA (Non-Operative Treatment of Appendicitis). Past RCTs were from Europe and this is the first NIH grant study to question this in the US. Antibiotic first strategies are used for uncomplicated diverticulitis, but have not been used in uncomplicated appendicitis. Several reasons why this strategy may be preferred include fewer complications, less pain, and less disability than an appendectomy first strategy. There have been a couple of systematic reviews on the issue of NOTA that came to different conclusions (Varadhan et al. BMJ 2012 and Kirby et al. J of Infection 2015). To date, no US randomized trial has evaluated an antibiotics-first approach in uncomplicated appendicitis until now.
Comment on author’s conclusion compared to REBEL Cast Conclusion: In this small pilot study, it seems reasonable to treat uncomplicated appendicitis as we would with uncomplicated diverticulitis.
REBEL Cast Bottom Line: Even though the results are very promising for using an antibiotic first strategy in acute uncomplicated appendicitis, a much larger trial would need to be performed before generalizability. Even so, this trial did show that outpatient ED management of uncomplicated appendicitis is feasible."