[Interval appendectomy as routine therapy or only as indicated: the controversy continues]

Although 3 retrospective studies from the Netherlands conclude that interval appendectomy should only be performed when indicated, i.e. when patients present with recurrent acute appendicitis or persistent pain, there is still no consensus in the literature regarding the management of these patients. This is probably due to the lack of sound studies needed to change the standard treatment and because surgeons prefer to adhere to the traditional strategy of interval appendectomy, although it is based on even less valid arguments. The risk of recurrent appendicitis is low, especially in adult patients. In this setting, the disease is generally less severe, and performing interval appendectomy only as indicated does not increase the risk ofcomplications. In contrast, routine interval appendectomy is associated with increased morbidity, longer hospital stays and greater costs. Colon malignancy, however, should be ruled out in patients over 40 years. It is still unclear whether the conservative strategy should also be preferred for paediatric patients, who may have a higher risk of recurrence. Faster and better diagnosis may further reduce the incidence ofappendiceal mass or abscess.