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Invited Commentary
February 19, 2020

Quality of Life—The Appendix

Author Affiliations
  • 1Department of Surgery, University of California, Los Angeles, Los Angeles
JAMA Surg. Published online February 19, 2020. doi:10.1001/jamasurg.2019.6029

Standing in front of the crowd that had gathered to witness the first water arriving in Los Angeles, California, after it had traveled 238 miles along the California Aqueduct from Owens Valley, the aqueduct’s builder, William Mulholland, said to the crowd, “There it is. Take it.”1 The same could be said for the Appendicitis Acuta (APPAC) study. The APPAC trial2 was a well-thought-out and hard-to-perform study breaking new ground by proposing to not perform appendectomy when, in fact, most surgeons believed that appendectomy was essential. Various readers have developed their own interpretations of what the study means. Appendicitis was successfully treated in 60% of the patients given antibiotics, motivating many clinicians to consider nonoperative treatment of appendicitis.3 That 40% of patients ultimately underwent surgery led others to criticize nonoperative treatment of appendicitis, stating correctly that appendectomy permanently cures appendicitis. Those critics also reacted unfavorably to the use of potent antibiotics, a requirement for a 3-day length of stay, and the performance of open rather than laparoscopic surgery to perform the appendectomy.

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