International audienceRespiratory complications are common after surgery. Several complex mechanisms such as postoperative diaphragmatic dysfunction, ventilation perfusion mismatching, atelectasis and pulmonary infection are responsible for such complications. Several scoring scales allow to evaluate the risk of postoperative pulmonary complications that depends especially of the surgical procedure performed (upper abdominal and thoracic surgery). Smoking cessation as soon as possible, chest physiotherapy, incitative spirometry and peroperative protective ventilation are the main preventive measures. Postoperative epidural analgesia plays a role but its impact is vanishing with the decreasing incidence of respiratory complications. Non-invasive ventilation, incitative spirometry and physiotherapy need to be maintained postoperatively in patients at risk.Les complications respiratoires sont fréquentes après chirurgie. Leur mécanisme physiopathologique fait intervenir plusieurs éléments : dysfonction diaphragmatique, anomalie de distribution de la ventilation, atélectasies, infection broncho-pulmonaire. Plusieurs échelles de score permettent d’apprécier l’importance de ce risque. Les épreuves fonctionnelles respiratoires sont en revanche inutiles dans cet objectif. La prévention des complications repose sur l’arrêt du tabac, la kinésithérapie et la spirométrie incitative ainsi que sur la ventilation protectrice peropératoire. En postopératoire l’analgésie péridurale conserve un impact sur la morbidité respiratoire moindre que dans les années précédentes. Les techniques de kinésithérapie, de spirométrie incitative et de VNI ont également un bénéfice démontré

International audienceRespiratory complications are common after surgery. Several complex mechanisms such as postoperative diaphragmatic dysfunction, ventilation perfusion mismatching, atelectasis and pulmonary infection are responsible for such complications. Several scoring scales allow to evaluate the risk of postoperative pulmonary complications that depends especially of the surgical procedure performed (upper abdominal and thoracic surgery). Smoking cessation as soon as possible, chest physiotherapy, incitative spirometry and peroperative protective ventilation are the main preventive measures. Postoperative epidural analgesia plays a role but its impact is vanishing with the decreasing incidence of respiratory complications. Non-invasive ventilation, incitative spirometry and physiotherapy need to be maintained postoperatively in patients at risk.Les complications respiratoires sont fréquentes après chirurgie. Leur mécanisme physiopathologique fait intervenir plusieurs éléments : dysfonction diaphragmatique, anomalie de distribution de la ventilation, atélectasies, infection broncho-pulmonaire. Plusieurs échelles de score permettent d’apprécier l’importance de ce risque. Les épreuves fonctionnelles respiratoires sont en revanche inutiles dans cet objectif. La prévention des complications repose sur l’arrêt du tabac, la kinésithérapie et la spirométrie incitative ainsi que sur la ventilation protectrice peropératoire. En postopératoire l’analgésie péridurale conserve un impact sur la morbidité respiratoire moindre que dans les années précédentes. Les techniques de kinésithérapie, de spirométrie incitative et de VNI ont également un bénéfice démontré

<p><strong>Background:</strong> Several Western studies support the idea that some acute appendicitis (AA) can be successfully treated by antibiotics. The rationale for the non-operative treatment is essentially based on the non-futility of the vermicular appendix which seems to play a major role in the pathophysiology of the digestive tract. However, this approach still suffers from a failure rate of around 20-30% in the first year, rising to nearly half of patients within 5 years. In Algeria, appendectomy is still the standard of care. Through rigorous selection, the Kouba non operative management of acute appendicitis (KNOMA) trial aims to determine whether non-operative treatment (NOT) is non-inferior to surgery.</p><p><strong>Methods:</strong> KNOMA is a randomized, controlled, non-inferiority trial designed to enroll 180 adults with CT-confirmed uncomplicated AA. Participants are randomized to appendectomy or 9 days of antibiotics (Abx). The primary endpoint is the failure rate at 12 months. This trial was designed to take into account the specifics of the Algerian population and practices in Algeria.</p><p><strong>Conclusions:</strong> This is the first trial in Africa and middle-income countries to evaluate the comparative efficacy of antibiotics and appendectomy for the treatment of CT-confirmed uncomplicated acute appendicitis based on failure rate assessment.</p><p><strong>Trial registration:</strong> This trial was registered on pactr.org on 28 March 2022 (PACTR202203751640059).</p>

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