Conclusion The paradigm remains unchanged , that appendectomy is the gold st and ard of treatment for uncomplicated appendicitis , given its higher efficacy rate when compared to NOM
Introduction Appendectomy has long been the mainstay of intervention for acute appendicitis , aim ing at preventing perforation , peritonitis , abscess formation and recurrence .
With better underst and ing of the disease process , non-operative management ( NOM ) with antibiotics alone has been proved a feasible treatment for uncomplicated appendicitis .
This article aim ed at systematic ally review ing the available literature s and discussing the question whether NOM should replace appendectomy as the st and ard first-line treatment for uncomplicated appendicitis .
The NOTA study: non-operative treatment for acute appendicitis: prospective study on the efficacy and safety of antibiotic treatment (amoxicillin and clavulanic acid) in patients with right sided lower abdominal pain
Background Case control studies that r and omly assign patients with diagnosis of acute appendicitis to either surgical or non-surgical treatment yield a relapse rate of approximately 14 % at one year . It would be useful to know the relapse rate of patients who have , instead , been selected for a given treatment based on a thorough clinical evaluation , including physical examination and laboratory results ( Alvarado Score ) as well as radiological exams if needed or deemed helpful . If this clinical evaluation is useful , the investigators would expect patient selection to be better than chance , and relapse rate to be lower than 14 % . Once the investigators have established the utility of this evaluation , the investigators can begin to identify those components that have predictive value ( such as blood analysis , or US/CT findings ) . This is the first step toward developing an accurate diagnostic-therapeutic algorithm which will avoid risks and costs of needless surgery . Methods / design This will be a single-cohort prospect i ve observational study . It will not interfere with the usual pathway , consisting of clinical examination in the Emergency Department ( ED ) and execution of the following exams at the physician 's discretion : full blood count with differential , C reactive protein , abdominal ultrasound , abdominal CT .  Patients admitted to an ED with lower abdominal pain and suspicion of acute appendicitis and not needing immediate surgery , are requested by informed consent to undergo observation and non operative treatment with antibiotic therapy ( Amoxicillin and Clavulanic Acid ) . The patients by protocol should not have received any previous antibiotic treatment during the same clinical episode . Patients not undergoing surgery will be physically examined 5 days later . Further follow-up will be conducted at 7 , 15 days , 6 months and 12 months . The study will conform to clinical practice guidelines and will follow the recommendations of the Declaration of Helsinki . The protocol was approved on November 2009 by Maggiore Hospital Ethical Review Board ( ID CE09079 ) . Trial Registration Clinical Trials.gov identifier : NCT01096927
Conclusion The paradigm remains unchanged , that appendectomy is the gold st and ard of treatment for uncomplicated appendicitis , given its higher efficacy rate when compared to NOM
Introduction Appendectomy has long been the mainstay of intervention for acute appendicitis , aim ing at preventing perforation , peritonitis , abscess formation and recurrence .
With better underst and ing of the disease process , non-operative management ( NOM ) with antibiotics alone has been proved a feasible treatment for uncomplicated appendicitis .
This article aim ed at systematic ally review ing the available literature s and discussing the question whether NOM should replace appendectomy as the st and ard first-line treatment for uncomplicated appendicitis .