Management of appendicitis: appendicectomy, antibiotic therapy, or both?

Area of Science:

• General Surgery
• Gastroenterology

Background:

• Appendicitis is a common surgical emergency globally, frequently misdiagnosed due to reliance on clinical assessment.
• Incidence varies, with higher rates in Western countries and rising rates in developing nations.

Purpose of the Study:

• To debate management strategies for appendicitis, including operative, nonoperative, and combined approaches.
• To review current literature on appendicitis treatment, considering pre- and post-COVID-19 pandemic evidence.

Main Methods:

• Comprehensive electronic searches of major databases (PubMed, Cochrane Library, Science Citation Index).
• Inclusion of original published studies and relevant textbook chapters on appendicitis management.

Main Results:

• Laparoscopic appendicectomy is the established gold standard for appendicitis treatment.
• Nonoperative management with antibiotics is a viable option for select uncomplicated appendicitis cases.
• Controversy persists regarding the optimal management of appendix mass/abscess.

Conclusions:

• While laparoscopic surgery is standard, open appendicectomy remains relevant.
• Antibiotic therapy can be effective for uncomplicated appendicitis, necessitating informed patient consent.
• The choice of appendicitis management requires careful consideration of individual patient factors and clinical presentation.