News — In pediatric medicine, there’s growing interest in treating kids and teens who have uncomplicated appendicitis with intravenous (IV) antibiotics instead of surgery.
It sounds like a leap forward. But how many of those kids will have a recurrence of severe belly pain and other miserable symptoms – possibly with the inflamed appendix bursting the second time?
Wouldn’t it be better to have low-risk laparoscopic surgery to remove the tiny, inflamed organ and get it over with?
Then again, how would you feel if your child was one of the five per cent of all appendectomy patients who turn out to have a normal appendix, meaning that the operation – and the risks of general anesthetic – were unnecessary?
And what if antibiotics could permanently solve the problem, leaving the child with an intact appendix – an organ once viewed as “useless” but now thought to play roles in the immune system and gut health?
Dr. Richard Keijzer, a pediatric surgeon at the Health Sciences Centre Winnipeg Children’s Hospital and professor of surgery at UM, was part of an international research team that has just published a study comparing the two treatment approaches. The project was conducted at 11 children’s hospitals across seven countries.
The six-year study was published in the prestigious medical journal The Lancet.
Led by researchers at Children’s Mercy in Kansas City, Mo., it’s the first large, randomized (unbiased) trial comparing the appendectomy and antibiotics approaches in children.
“We studied 936 young patients – 57 of them in Winnipeg – with their parents’ permission, randomizing them into two treatment groups,” says Keijzer, who is also affiliated with the Children’s Hospital Research Institute of Manitoba. “They ranged in age from five to 16 and had suspected non-ruptured appendicitis.”
The researchers followed up one year after each child’s episode of appendicitis.
The antibiotic treatment had a failure rate (meaning that the child needed an appendectomy during that year) of 34 per cent. The surgery had a failure rate (meaning that the removed appendix was normal when examined, or the child had a serious complication related to appendicitis during the year) of 7 per cent.
“The difference between the two was 27 percentage points, which exceeded the 20 percentage points that we had deemed acceptable,” Keijzer says. “We declared the antibiotic treatment inferior in this trial.”
The children in the surgery group spent less time in hospital (the antibiotics group had to be monitored longer), but those who got antibiotics returned to school and their normal activities faster.
Keijzer says he’s proud that local families were involved in the trial. “We knew that this was an important study, answering a question about a very common disease in children in a well-designed trial.”
The participating families varied in how they viewed the two treatment approaches, he says.
“Some just wanted to get it over with and wanted the appendectomy, whereas other families did not want to do surgery if there was a medical treatment available.
“Now that we know from this clinical trial that about one-third of patients treated with antibiotics will eventually need an appendectomy, we can have better-informed discussions with families.”
At the Winnipeg Children’s Hospital, Keijzer says, “Most kids with appendicitis currently receive a laparoscopic appendectomy, but the antibiotic option is available and can be discussed with future patients and their families.”
For more information: Alison Mayes, Rady Faculty of Health Sciences, University of Manitoba, [email protected]
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