Surgeon Questions Appendicitis

Is surgery always needed for appendicitis?

My father was diagnosed with appendicitis recently, but he doesn't have an appendectomy scheduled because he has very mild symptoms. His doctors aren't really treating it as an emergency, and I was always under the impression that surgery is necessary for appendicitis. Would he need surgery eventually to remove his appendix?

7 Answers

Acute appendicitis pain that doesn't resolve in a few days can most likely proceed to rupture. Antibiotic treatment is tried all over the world with some positive outcomes. However, since laparoscopic surgery produces a quick recovery, it becomes more advisable to get the appendix out now.
Sometimes, it can be cooled down with Abx.
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Yes he will have to have surgery if he keeps on having problems with his appendix. But I would hope he never has to have it removed. He just needs to do what the doctors tell him and he will be OK. I do wish him well. oledochouse
No, there is a growing trend towards non-surgical management of mild, early acute appendicitis. If he met the criteria, it is very possible that he will be successfully managed in the “acute” settings without surgery. The risk he runs is recurrent (or future) appendicitis, which is typically ~25%. It is still not “mainstream” to treat patients without surgery, but many surgeons and hospitals are employing this treatment strategy. If patients are managed non-operatively during the acute setting, there is not absolute indication that he should undergo an “elective” appendectomy in the future. Only for recurrent symptoms (or return of symptoms) after antibiotics completed.
If appendicitis is caught very early, IV antibiotics for several days, then by mouth antibiotics for a couple of weeks or so, has been reported to “work.” However, if I ever have appendicitis, I want a good general surgeon to remove it laparoscopically, if it’s possible.
The mainstay treatment for acute appendicitis is antibiotic therapy. Antibiotics will treat this condition without the need for surgery in most cases. However, some patients will require emergent surgery depending on their condition. Surgery is usually suggested either urgently or in a delayed fashion to prevent recurrent infection. Some patients may have an abscess that requires drainage and antibiotics before surgery, others may benefit from urgent surgery to relieve symptoms quickly. Although, appendectomy is not absolutely required to treat appendicitis, it is suggested as the best therapy in addition to antibiotics.
Generally accepted treatment is removal of appendix with surgery. Some surgeons have tried treating only with intravenous antibiotics, but I won't suggest it unless the risk of anesthesia significantly endangers the patient's life more than not removing the appendix.