Appendicitis Treatment: What to Know About Surgical and Non-Surgical Options

Appendicitis treatments don't always look like what you see in the movies, when a character is rushed to the operating room. Even though surgery is still a go-to procedure, many people with uncomplicated appendicitis can be treated with medication alone.

You got that right: Appendicitis treatment without surgery is a very real possibility. There's increasing support for the use of antibiotics to treat this all-too-common medical emergency, which happens to up to 9% of people at some point in their lives, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Here, we'll take a closer look at how non-surgical treatment for appendicitis works, and why going under the knife might still be the best option for some people, in some cases.

What is the treatment for appendicitis?

Appendicitis treatments can involve antibiotics and/or surgery, depending on how severe the inflammation is.

Before weighing your appendicitis treatment options, here's a quick anatomy lesson: The appendix is a finger-like pouch attached to the end of the large intestine. For many years, it was considered a vestige of human evolution without much practical use. Now there's a theory that the appendix plays a role in restoring the gut microbiome after a diarrheal illness, according to a 2013 article published in the World Journal of Gastroenterology.

While scientists haven't been able to definitively say what function the appendix serves, there appear to be no ill effects from its removal, per Harvard Health Publishing. (Hence why surgery is a mainstay appendicitis treatment.)

Appendicitis, or inflammation of the appendix, is a common cause of acute abdominal pain. Often, an appendicitis attack occurs due to some blockage in the appendix, according to the Mayo Clinic, like hard stool or some other obstruction. Whatever the cause, bacteria begin to proliferate, causing the organ to become inflamed. It fills with pus and it can then rupture if you don't receive appendicitis treatment.

Anyone can get appendicitis—and it's not clear why some people do and others don't—but it often occurs in children and young adults ages 10 to 30, per the US National Library of Medicine (MedlinePlus).

Appendicitis treatment without surgery

Appendicitis treatment doesn't have to mean going under the knife. In fact, antibiotics can delay the need for surgery for appendicitis in adults—or prevent a trip to the operating room entirely.

In guidelines issued during the COVID crisis in late 2020, the American College of Surgery (ACS) acknowledged that there is now "high-quality evidence that most patients with appendicitis can be managed with antibiotics instead of appendectomy."

That evidence includes findings from the largest randomized trial to date comparing appendicitis treatment options: Results of the CODA (Comparison of Outcomes of Antibiotic Drugs and Appendectomy) trial, published in the New England Journal of Medicine, suggest that an "antibiotics first" approach to treating appendicitis is just as good as surgery for some people. Seven in 10 adults safely avoided surgery for at least three months after initial appendicitis treatment with antibiotics, the study found. The findings highlight the benefits and risks that patients and their doctors must consider when deciding between appendicitis treatment options.

In other words, antibiotics may be the best appendicitis treatment option for some patients, at least in the short term. This is especially true for those with mild cases of appendicitis, per the NIDDK. Patients in the CODA trial will continue to be followed to assess longer-term outcomes.

As for whether antibiotics alone are used to treat appendicitis may depend on patient and surgeon preferences, as well as the stage of the condition.

About 80% of cases are "uncomplicated," meaning that the appendix itself is intact but inflamed, David Talan, MD, professor of emergency medicine at the David Geffen School of Medicine at UCLA and the CODA trial's co-principal investigator tells Health.

"While patients with severe abdominal pain should seek medical evaluation promptly, for most patients who are found to have appendicitis, it is uncomplicated and not an emergency," he says. These patients, once placed on antibiotics, may have time to choose between surgery or continued antibiotic treatment for appendicitis.

Appendicitis treatment with surgery

Surgery has been the standard treatment for appendicitis for decades. There are two surgical appendicitis treatment options:

• Laparotomy: Also known as an "open" appendectomy, this procedure involves a surgeon removing the appendix through a single incision in the lower right side of the abdomen.
• Laparoscopic appendectomy: This procedure involves multiple, smaller incisions through which the surgeon manipulates a lighted camera and surgical tools to remove the appendix.

In a review of clinical trials comparing these two appendicitis treatment options, laparoscopic surgery was associated with reduced pain during recovery, lower risk of wound infection, a shorter hospital stay, and more rapid return to normal activities in adults. The disadvantage? A higher rate among adults of intra-abdominal abscess—a collection of pus or infected fluid surrounded by inflamed tissue. Among kids who received this appendicitis treatment, there was a reduced risk of wound infection and shorter hospital stays and no increased rate of abscess.

However, laparoscopic surgery might not always be the best appendicitis treatment option in every case. According to the Mayo Clinic, a surgeon may need to perform an open procedure to clean out the abdominal cavity if the appendix bursts.

Sometimes a procedure to drain an abscess of pus and fluid is performed prior to surgery. Once the infection clears up, the patient can have a surgical appendicitis treatment several weeks later.

If you experience symptoms of appendicitis, such as a sudden pain in the lower right side of your abdomen, get medical attention ASAP. Your doctor can diagnose what's going on, and help you find the best appendicitis treatment for your situation.