Surgery should remain the mainstay of treatment for acute uncomplicated appendicitis

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An RCSI study conducted in Beaumont Hospital in Dublin has found that surgery, rather than antibiotics only, should remain as the mainstay of treatment for acute uncomplicated appendicitis.

Published in Annals of Surgery and led by researchers from RCSI University of Medicine and Health Sciences, the study is called the COMMA trial (Conservative versus Open Management of Acute uncomplicated Appendicitis). It examined the efficacy and quality of life associated with antibiotic-only treatment of acute uncomplicated appendicitis versus surgical intervention. The results revealed that antibiotic-only treatment resulted in high recurrence rates and an inferior quality of life for patients.

Acute uncomplicated appendicitis is a common surgical condition. Traditional management has involved surgery to remove the appendix (appendectomy). Antibiotic-only treatment has emerged as a potential alternative option that could offer benefits to patients and hospitals, such as a faster recovery, less scaring and pain, a better quality of life for patients and reduced demand on operating theatres. There has been a reluctance to adopt antibiotic-only treatment, however, due to previous research showing wide variability in failure rates and a lack of evidence regarding the impact on quality of life for patients.

In the COMMA study, 186 patients with radiological evidence of acute, uncomplicated appendicitis were randomised into two groups. One group received antibiotic-only treatment and patients in the other group underwent a laparoscopic appendectomy. In those treated with antibiotics only, intravenous (IV) antibiotics were administered until there was an improvement in the patient's signs and symptoms, followed by five days of oral antibiotics.

In the weeks and months following treatment, patients completed questionnaires, including a quality of life questionnaire at one week, one month, three months and one year. At these points, the patient's pain score, need for additional sick leave, surgical site infections and any development of recurrent appendicitis were recorded.

In the antibiotic-only group, 23 patients (25%) experienced a recurrence of acute appendicitis within one year. In the surgery group, the quality of life questionnaires found that patients experienced a significantly better quality of life score compared with the antibiotic-only group.

Professor Arnold Hill, Head of School of Medicine and Professor of Surgery at RCSI, said: "Antibiotic-only treatment of acute uncomplicated appendicitis has been proposed as an alternative, less-invasive treatment option for patients. The COMMA trial set out to establish if antibiotic-only treatment could replace surgery in some cases, which could offer many benefits for patients and hospitals alike. The results indicate that the treatment protocols should not change. Surgery will deliver the best outcomes for patients in terms of quality of life and recurrence and therefore should remain as the mainstay of treatment for acute uncomplicated appendicitis."

The study was carried out by researchers from RCSI and Beaumont Hospital, Dublin. The research was supported by RCSI.