A standardised approach, including VATS, is associated with a high cure, low revision and moderate conversion rates. In view of a still considerable mortality, a higher index of suspicion and detection of advanced stages, especially in younger patients, is required to improve outcomes.
Since January 1981, the so-called "3-day principle" in cases of suspected appendicitis has been applied in order to render the indications for surgery more precise. The retrospective analysis of a total of 1877 appendectomies performed between 1981 and 1990 demonstrated that the majority of histologically definite cases of acute appendicitis had been surgically treated on the day of admission to hospital. Furthermore, a second peak of histologically evident cases of acute appendicitis was seen with non-characteristic symptoms on the 3rd day. An additional remarkable finding was that 38.0% (!) of all appendices intraoperatively declared to be "innocent" showed histologically definite inflammatory alterations.
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