NATALIA

The Northwick Park Appendix Trial – Antibiotics, Laparoscopy or Imaging in Acute Appendicitis

Photo credit: wellcome images / Foter / CC BY-NC-ND

A Multicentre Randomised Controlled Trial of Non-operative vs conventional operative management of Acute Appendicitis

For over 100 years surgeons have thought that inflammation of the appendix inexorably leads to perforation. This faux knowledge has been challenged and over the last twenty years. A small number of case reports and clinical trials have suggested that acute appendicitis can be managed non-operatively with antibiotics.

We now intend to set up a multicentre double randomised controlled clinical trial of operative versus non- operative management of acute appendicitis in early acute appendicitis. Our hypothesis is that non-operative management of early acute appendicitis with antibiotics will reduce the need for surgery by 30%, and that imaging will improve the diagnostic rate of acute appendicitis and thus reduce the histologically normal appendix rate of 20% to 5%.

Imperial College London, in collaboration with the London Surgical Research Group