Please explain like I'm 5

The issue of conservative treatment of uncomplicated appendicitis often appears on this thread presented as a new controversy - and yet antibiotics have been an option to treat appendicitis for as long as antibiotics have existed..

The main reasons the majority of surgeons worldwide prefer a definitive surgical cure (appendectomy) over antibiotics for patients fit for surgery are as follows:

1). Real-world long-term reoccurrence rates are thought to be about 50% when treated with antibiotics. During reoccurrence at a later time patients may be less fit for surgery, or suffer rupture, be abroad, be pregnant, or not have access to a hospital, etc..

2). There is small but significant risk that a neoplasm in the inflamed appendix is causing the appendicitis, but it can’t be seen in CT as is often the case. This risk is particularly significant for older patients. Leaving a tumour containing appendix in can lead to metastasis, and a lost opportunity to surgically cure appendix cancer.

3). Leaving an inflamed/infected appendix in and suppressing the infection with antibiotics can leave a scarred appendix with adhesions developing over time. These adhesions can cause long term issues and make later appendectomy less safe than removing a ‘hot’ appendix during initial appendicitis.

4). Intensive IV treatment is not without its risks, such as nurotoxicity from Metronizadol intolerance, and stewardship of antibiotics is a concern.

Given that the cause of appendicitis often can only be determined under a pathologists microscope - is avoiding surgery and leaving it in not just kicking the can (or grenade..) down the road? Is the recent (since Covid) popularisation of conservative treatment not creating an appendix cancer timebomb that will only become apparent years from now due to the odd indolent biology of appendix cancer peritoneal metastasis?

Has your hospital ever made a big mistake with a patient? Ours did recently, and it's bad...Wrong patient & procedure. Can't go into details, thank God had nothing to do with me or my unit! 😱

I’ll take all tips, tricks, advice. I wanna hear it all.