Jeg er kull V-09. Dette var det ikke mulig å velge.
Jeg har gjort et litteraturstudie med vekt på sammenligning mellom antibiotika og kirurgi som behandling ved akutt appendicitt. Randomiserte kontrollerte studier er prioritert for å få et best mulig innblikk i god litteratur som finnes på området.
Oppgaven er en oversikt som belyser ulike vinklinger rundt temaet behandling av akutt appendicitt. Temaer jeg har lagt spesielt vekt på er randomisering, komplikasjoner og diagnostikk.
Objective: Acute appendicitis is a common disease with a lifetime risk of 7-8% . The highest incidence is between the age 10 and 20 . The treatment has always been appendectomy, which is a universally accepted surgical procedure. There have recently been published several randomized controlled trials comparing appendectomy with conservative antibiotic treatment. The main objective of this paper is to summarize and assess the clinical applicability of these data, discussing whether or not this conservative treatment may be acceptable as first line of therapy for some – possibly many - patients with acute appendicitis. The main issues of controversy are diagnostic challenges, patient selection, definition of treatment success and complications and finally the mere randomization procedure in each trial. Methods: I have reviewed randomized controlled trials, comparing the two treatment modalities, and meta-analysis on the subject. Only one Cochrane report was found, which is included in the present review. It is based on literature search in PubMed and Cochrane library of systematic reviews. Results/conclusion: There are some similarities among the trials: The complication rate is higher after appendectomy, than it is after antibiotic treatment, and the time of follow up is very short in all trials. Some authors claim that antibiotic treatment is safe when appendectomy can be performed within 24 hours, if the patient does not improve. The documentation is not good enough to exclude that 24 hours delay generates increased risk of serious complication for the patient. Serious complications that can occur after both conservative and surgical treatments are not fully explored in any of the trials.