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The longest follow-up of patients with acute appendicitis treated nonoperatively has been 5 years in the published literature. Now, Swedish researchers report 25-year outcomes for 137 patients who were treated nonoperatively in two early randomized trials — conducted in the 1990s — that compared appendectomy with nonoperative antibiotic treatment.
Nonoperative treatment failed during the index hospital admission in 15% of the patients, and another 25% underwent appendectomy at some later time (typically during the first year after the initial clinical presentation). Thus, 60% of these patients had not undergone appendectomy by the end of the 25-year follow-up. No patients underwent surgery for bowel obstruction, and no appendiceal tumors wer…