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An Overview of Appendix
The appendix is a tube, the size of a finger, that extends from the colon on the junction of the large and small intestines. The junction which is crucial for digesting and absorption, extends to the colon whose purpose is to reclaim water and remove waste products. An inflammation of the appendix is called appendicitis. If the appendix becomes swollen and gets infected, you have appendicitis. It may rupture as a result of this. The infection can spread throughout the abdomen, leading to issues like peritonitis or an abscess around the appendix.
What is the function of the appendix?
The theory that the appendix acts as a reservoir for good bacteria that aids the digestive system in recovering from diarrheal disorders is widely debated, despite the fact that the specific function of the appendix is still unknown. According to some experts, the appendix is a pointless remnant of our evolutionary past. Surgery to remove the appendix doesn’t seem to impact the health negatively.
Surgery is the first line of treatment for appendicitis
The common causes of appendicitis include bacteria, viruses, parasites, or fungi. Appendicitis may develop whenever there is a physical obstruction of the appendix’s entrance, such as a tumour, hardened faeces, or if there is swelling or inflammation. The risk of appendicitis comes from the appendix’s propensity to rupture or perforate, which triggers an infection that can spread throughout the abdomen.
Doctors treat appendicitis by surgically removing the appendix with an appendectomy. And intravenous fluids and antibiotics play a significant role during the procedure. In actuality, appendectomy is among the most frequent abdominal surgeries performed globally. The laparoscopic procedure or “keyhole” or minimally invasive surgery is preferred to treat most appendectomies. Typically, patients stay in the hospital for no longer than 24 hours following surgery.
Snapshot of antibiotics used during procedures
Antibiotics are designed to treat infections and minimise complications. Antibiotics are crucial in the treatment of various conditions, including appendicitis. The severity of the appendicitis at the time of diagnosis directly impacts how long the administration will last. Appendicitis antibiotic medicines are effective in lowering the postoperative wound infection rates. The meds also help improve the outcomes in patients with appendiceal abscess or septicemia.
Appendicitis antibiotics include drugs like cefotetan, ceftriaxone, cefotaxime, piperacillin and tazobactam, ampicillin and sulbactam, and gentamicin. Appendix medicine also includes ertapenem, metronidazole, meropenem, clindamycin levofloxacin among others.
Can antibiotic-only treatment do the trick?
Recently, many studies have demonstrated that surgery may not be necessary for all cases of appendicitis. The studies proved that doctors could treat uncomplicated appendicitis—appendicitis without a ruptured appendix, pus-filled abscesses, or peritonitis—without appendectomies. An antibiotic-only regimen can work in its place. In clinical trials, individuals with uncomplicated appendicitis who received only appendix medicine or antibiotic treatment needed fewer doses of medication. Also, they could return to work sooner and did not experience a higher perforation risk than those who had an urgent appendectomy.
An “appendicitis medicine first” strategy may be helpful for those who have experienced difficulties from an earlier surgery. According to some studies, half of those who received antibiotic therapy faced the risk of recurrent appendicitis, which could necessitate an appendectomy in the future. Another study found that 20% of patients who had antibiotic therapy experienced appendicitis within a year, and 20% of those patients needed treatment for an appendix rupture and the related comorbidities in their recurrent appendicitis episode. Nevertheless, over the one-year follow-up period, most patients who received appendicitis medication treatment did not need an appendectomy, and did not face any problems.
Although appendectomy is still the ‘gold standard of treatment’ for simple appendicitis due to its efficacy, researchers found that nonoperative treatment or prescribing appendix antibiotics is a feasible and effective alternative for uncomplicated appendicitis.
Researchers Vs doctor’s point of view
Researchers point out that it would be challenging to convince patients and their doctors to accept appendicitis medicine alone for appendicitis, even with evidence that is quite persuasive that antibiotics are a feasible treatment regimen.
These studies contain several drawbacks, as is always the case in scientific research, including a simple study design, numerous confounding variables, incorrect interpretation of the data, and inherent errors that are obvious to anyone using statistics. Many doctors consider the failure rate of antibiotics is too high and shouldn’t be considered as an alternative to surgery. Although some people can avoid surgery with the support of antibiotics, not everyone can.
Antibiotics vs. Surgery: Doctors can evaluate treatment options with patients
Surgeons point out that if the medications are ineffective in treating the illness, there is always a chance that the appendix will explode. Surgery carries some risks of its own. A conversation with patients about the benefits and risks of each therapy option, along with medical management of appendicitis can be helpful. You must consider how unwell you are as well. All patients would likely forego surgery if they did not have a fever, vomiting, or a high white blood cell count. At the time of diagnosis, if the appendicitis is serious, surgery is almost certainly required. Ask yourself, “Are you alright with a 30–40% higher chance of requiring an operation in the future if antibiotics are your only option?”
The final word?
According to the American College of Surgeons appendicitis treatment guidelines and the Comparing Outcomes of Antibiotic Drugs and Appendectomy (CODA) overall research study, antibiotics are now regarded as the first choice of treatment for the majority of patients with appendicitis. Given these findings and the revised treatment recommendations, patients and surgeons must weigh the benefits and drawbacks of both surgery and antibiotics before deciding on the course of action that can heal appendicitis, which will be most beneficial for that particular patient.
