Treatment of appendicitis, Appendectomy

With few exceptions, the treatment of appendicitis is surgical (ie, appendectomy). The operation can be done open  or laparoscopically. The results of clinical trials comparing the two methods show no clear-cut advantage of one method over the other, though patients treated laparoscopically return to work a few days earlier. A laparoscopic approach is desirable when the preoperative diagnosis is uncertain because the morbidity is less if the appendix is found to be uninflamed and an appendectomy is not done.

Prophylactic antibiotics are indicated preoperatively. A single-drug regimen, usually a cephalosporin, is as effective as more aggressive multiple-drug combinations. Routinely culturing abdominal fluid is of no practical value even when the appendix has perforated. The organisms obtained are the usual fecal flora.

Abdominal drains are called for only to treat established abscesses, not for diffuse inflammation or abdominal fluid.

If a patient with appendicitis cannot be taken to a modern surgical facility for care, treatment should consist of antibiotics alone. The complication-free success rate of this approach is high.