Abdominal Surgeon Questions Appendicitis

Does appendicitis require immediate surgery?

My daughter was diagnosed with appendicitis, but her doctor is holding off on having it removed and wants to monitor it instead. I always thought appendectomies are emergency procedures. Why aren't they acting on her appendicitis sooner?

4 Answers

Appendectomies are not always emergent, actually they are seldom emergencies. There are new studies that have looked at managing appendicitis with antibiotics alone. However, there needs to be discussion as to the potential complications of nonoperative management versus the complications of operative management. Ultimately if the patient has been managed successfully without surgery the appendix is still there and there is always a risk of having appendicitis in the future. None of the recent studies address the risk of recurrent appendicitis in the future. Depending on how the patient is doing clinically, surgery may be necessary.
Traditional teaching is that appendicitis is a surgical emergency and patients would typically be taken to the operating room within 4-6 hours for an appendectomy. There is newer research stating that appendicitis may be treated with antibiotics alone, sparing people the risk of surgery. The recurrence rate with this may be up to 30% at 2 years, and even higher thereafter. I personally do not recommend non-operative management for my patients unless they are too sick to tolerate a surgery, but understand the reasoning of surgeons who are attempting a non-surgical option.
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The mainstay treatment for acute appendicitis is IV antibiotics. Some patients will have severe abdominal pain and will not have stable vitals and will require urgent surgery, but not all patients will require immediate surgery. Most patients, depending on how badly the infection has spread, will undergo surgery within 24 hours.
In 2019 there is evidence that supports both approaches: operating and waiting. The most important thing for you to know is that both approaches are safe but have unique risks. Feel free to ask your physician team questions about why they are choosing to wait.