Methodological limitations of NOM in the WSES acute appendicitis guidelines

The 2025 WSES Guidelines endorse nonoperative management (NOM) for uncomplicated acute appendicitis. However, the oncologic risks and methodological limitations of this approach require strict scrutiny. Applying the GRADE framework, admission computed tomography presents severe clinical indirectness, underestimating microperforations and failing to exclude occult appendiceal neoplasms in up to 3.2% of cases. Furthermore, contemporary data demonstrate that NOM recurrence rates reach 42.6% at three years. The perceived safety profile of initial antibiotic therapy is skewed. Definitive anatomical resolution and operative safety must remain the primary endpoints in emergency surgical care.