Surgical treatment has been considered the "gold standard" in the therapy of acute appendicitis for many years. Nevertheless, modern diagnostic methods and effective targeted drugs give many patients a chance to cure the disease by non-surgical measures. Choosing the specialized hospital in Germany, Switzerland, Turkey, Israel or other country with excellent medical care and high success rates, you may receive the desired result without surgery or undergo minimally invasive and safe operation.
Examination is the basis for choosing the therapeutic regimen
In most cases, a general practitioner suspects the pathology based on patient’s symptoms, medical history, and results of a physical examination. First, a doctor will ask a bunch of questions regarding the symptoms and previous health history. These include information about:
- Exact pain location, migration of pain across the abdomen
- Severity and duration of pain
- Presence of other symptoms, like fewer or unusual bowel movements
- Presence of concomitant medical conditions, recent surgical procedures
- Using of medicines, illegal drugs or alcohol consumption
Depending on the answers and results of the physical examination (checking psoas sign, Rovsing's sign, rebound tenderness, etc.), a general practitioner or surgeon proceeds to the laboratory tests. These include blood tests (they can show signs of infection), urinanalysis (for excluding renal colic) and pregnancy test in women (for excluding ectopic pregnancy).
Imaging tests are the conclusive examinations in confirming the diagnosis of appendix inflammation or finding other causes of the abdominal pain:
- Abdominal ultrasound is an easily performed, painless and cost-effective procedure that can reveal signs of the appendix inflammation or blockage, burst appendix, as well as other causes of pain
- CT scan of the abdomen gives more detailed picture of the abdominal organs and can additionally reveal an appendiceal abscess
- MRI of the abdomen is a reliable and safe alternative to a CT scan
The comprehensive diagnostics determines the therapeutic regimen. The acute appendicitis is a medical emergency that is connected with risk of peritonitis development and requires urgent surgery. The same time, appendicitis with minimal risks can be successfully treated with conventional measures.
Conventional treatment is suitable in a number of patients
For over 100 years, before wide antibiotic administration, surgery was the principal treatment option in patients with the acute appendicitis. Nevertheless, during the last decade the paradigm has shifted to the treatment of uncomplicated appendicitis with anti-inflammatory medications and antibiotics. Avoiding surgery is especially beneficial in children and debilitated patients.
The conservative treatment of appendicitis includes administration of the third-generation cephalosporin antibiotic (e.g. cefotaxime) 2 g twice daily in combination with the nitroimidazole preparations (e.g. tinidazole) 800 mg daily. Being discharged from the hospital after the improvement, patients should continue taking quinolone antibiotics (e.g. ofloxacin) 200 mg twice daily in combination with the nitroimidazole preparations 500 mg twice daily for up to 8 days.
Non-surgical therapy allows preserving the appendix, which produces the mesenchymal stem cells. After the differentiation, mesenchymal stem cells give origin to myoblasts, lipoblasts, and osteoblasts. In addition, the appendix contributes to maintaining normal gut flora. It serves as the reservoir for useful bacteria and helps recolonizing the bowel after infections and antibiotic therapy.
Despite safety, effectiveness and excluding surgical risks (i.e. bleedings, infections, stress), the conservative therapy is not suitable for all patients. Patients with appendiceal abscess, burst appendix and peritonitis must undergo surgery. In addition, it is associated with certain relapse risks. The success rate of antibacterial therapy reaches 84%, while the relapse occurs in up to 21% of patients during the first year of the consequent follow-up.
Surgical treatment as the curative measure
Surgery is the only possible treatment option in patients with the severe pain syndrome and progressive deterioration, burst appendix and peritonitis, or when doctors cannot make a clear diagnosis. Appendectomy is removing the diseased appendix by means of the keyhole surgery (laparoscopy) or open intervention.
Laparoscopic appendectomy is carried out via 1-3 tiny cuts in the abdominal wall. A laparoscope equipped with video camera and surgical instruments reaches the target area inside the abdomen, so a doctor can see the operative field on the monitor and perform all the manipulations. The keyhole surgery shortens hospital stay, causes less pain, and promotes quicker normalization of the bowel function. If necessary, it can be converted to the open surgery, particularly in patients with:
- Signs of infection or appendiceal abscess
- Signs of perforated appendix
- Poor organs visualization, obesity
- Scar tissue in the abdomen due to the prior abdominal surgeries
- Uncontrolled bleedings (rare cause)
Open appendectomy provides a surgeon with better visualization of the operative field and better approach to the appendix and neighboring organs. Thus, it is superior to the keyhole procedure in complicated and atypical cases. A single large cut in the right lower side of the abdomen is made under the general anesthesia. After the appendix removal, revising the abdomen for the signs of peritonitis and careful hemostasis, a surgeon closes the operative wound with regular or dissolvable stitches.
Choosing hospital worldwide with Booking Health
Those patients, who want to use all the possibilities of the appendicitis treatment, and not just undergo surgery, often seek help in the specialized clinics of foreign countries. The international medical tourism provider Booking Health offers help in medical and organizational aspects of undergoing diagnostics and therapy in Germany, Turkey, Israel and other countries.
In accordance with the requirements of the international quality control certificate ISO 9001:2015, Booking Health takes care about:
- Choosing the optimal hospital
- Establishing communication with the chosen physician
- Preparing the diagnostic and possible treatment program in advance, excluding unnecessary interventions
- Booking the hospitalization date or outpatient appointment
- Monitoring all stages of medical program
- Providing favorable prices for medical and related services, excluding overpricing and saving up to 50%
- Control of invoices and final calculation
- Medical insurance against the cost for treatment increase (а coverage of 200,000 EUR, valid for 4 years)
- Communication with hospital and physician after the treatment completion
- Organization of additional and follow-up examinations
- Offering the related service of the highest level: booking hotels and tickets, transfer organization, interpreting services
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova