The main treatment for appendicitis today is the same as it was 100 years ago: surgery. Nowadays, though, patients with the condition—which occurs when the appendix becomes inflamed—benefit from shorter hospital stays, smaller scars, and fewer complications.
The standard treatment for appendicitis is an appendectomy surgery, or removal of the appendix (the finger-shaped organ has no known use in the body). An appendectomy is a relatively simple procedure that's performed about 300,000 times a year in the U.S. With this type of surgery, however, it's important to act quickly, before the appendix bursts and spreads bacteria into the abdomen. If this occurs, it can lead to peritonitis, a potentially life-threatening infection.
"Removing an appendix is pretty straightforward if you get to it early," explains Dmitry Oleynikov, MD, director for the Center for Advanced Surgery at the University of Nebraska Medical Center in Omaha. "If it's after it has burst, it's very complicated."
Generally, "early" means within 24 hours after severe symptoms—rapidly worsening abdominal pain, fever, chills, vomiting, or diarrhea—set in and a CT scan or abdominal ultrasound has determined it is appendicitis.
Here, the two types of surgery that can be used to remove the appendix. Plus, what you need to know about using only antibiotics to treat appendicitis.
If the appendix hasn’t burst, laparoscopic or "keyhole" surgery is usually the preferred procedure. During laparoscopic surgery, the surgeon makes several smaller cuts in the abdomen and, with the help of a laparoscope (a tiny instrument with a light and lens), removes the appendix. Patients who undergo laparoscopic surgery usually have faster recovery times, leaving the hospital within one to two days and resuming physical activity after five.
"There's less pain, increased mobility, and fewer instances of wound infections," says Robert Glatter, MD, an emergency physician at Lenox Hill Hospital in New York City.
If the appendix has burst, however, doctors usually opt for an open appendectomy, or laparotomy. With this type of surgery, the surgeon makes one bigger incision in the lower right section of your abdomen to remove the organ. If the appendix has burst and caused an abscess to form, the surgeon will also place a tube in the stomach to drain it. Full recovery could take up to two weeks.
Antibiotics have a traditional role in helping to treat appendicitis since they're often given before or after surgery to ward off infection. In cases where the appendix has burst, surgeons may wait to operate until antibiotics have had time to tame the infection.
But some doctors are now also turning to antibiotics to treat appendicitis in certain uncomplicated cases in which the appendix hasn't ruptured. In a 2015 study published in JAMA, researchers from Finland divided 530 people with uncomplicated appendicitis into two groups: one group underwent appendectomy surgery, while the other received antibiotics. After a one-year follow up period, only about a quarter of patients in the antibiotics group needed surgery.
While doctors in the U.S. continue to debate whether or not antibiotics are in fact a viable alternative to surgery for some appendicitis cases, "it's something that's becoming part of our vocabulary in how we treat appendicitis," says Glatter. "In Europe, it's very standard procedure."
Either way, if you think you're experiencing symptoms of appendicitis, it's critical to receive medical attention right away.
"If somebody develops fairly significant pain on the belly button which starts moving to the right and if it's not getting better over the course of couple of hours, it may not be appendicitis," says Oleynikov. "But, boy, you don't want to miss appendicitis."