Current opinions and practices for the management of acute appendicitis: an international survey

Abstract

Background In recent decades the management of acute appendicitis has evolved significantly. Improved access to early imaging and better clinical scoring algorithms have resulted in less negative appendicectomy rates. In addition, non-operative management has become increasingly utilized. The aim of this study was to assess the variability of management of acute appendicitis globally. Methods This was a multinational targeted survey of general surgeons across 39 countries. A structured set of questions was utilized to delineate nuances between management styles of consultants and trainees. Opinions on the pathological diagnosis of appendicitis, acceptable negative appendicectomy rates, and the role of non-operative treatment of appendicitis (NOTA) were surveyed. Results A total of 304 general surgeons responded to this survey, 42% of which were consultants/attendings. Sixty-nine percent advocated that a histologically normal appendix was the most appropriate definition of a negative appendicectomy, while 29% felt that anything other than inflammation, necrosis, gangrene, or perforation was more appropriate. Forty-three percent felt that negative appendicectomy rates should be less than 10%, with 41% reporting that their own negative appendicectomy rate was < 5%. Interestingly, only 17% reported routinely using NOTA for uncomplicated appendicitis, with one-fifth stating that they would undergo NOTA if they themselves had uncomplicated appendicitis. Conclusion This study represents the largest sampling of management strategies for acute appendicitis. It shows substantial global heterogeneity between clinicians regarding what constitutes a negative appendicectomy as well as the appropriateness of non-operative management.

Randomized clinical trials comparing antibiotic therapy with appendicectomy for uncomplicated acute appendicitis: meta-analysis

“…In real-world practice, negative histology rates may be as high as 20 per cent 1 and resection of a histologically normal appendix is seldom seen as treatment failure. Latest guidelines recommend the removal of the macroscopically normal appendix in symptomatic patients when no alternative pathology is identified at surgery 37 ; a view shared in large surveys of surgeons 44–46 . In addition, a recent study has suggested that when resected for right iliac fossa pain, appendices with normal appearances on conventional histology stained positively for pro-inflammatory markers on immunohistochemistry 47 .…”

Management of uncomplicated acute appendicitis during the COVID-19 pandemic: Appendectomy or non-surgical treatment?

“…[ 2 , 3 ] Appendectomy, first described by McBurney in 1889, has been widely accepted as the standard treatment method for acute appendicitis. [ 4 , 5 ] Recent studies have proposed that antibiotic therapy may be an alternative to appendectomy for the treatment of uncomplicated appendicitis. [ 6 ] This concept was first described by Coldrey in 1959, in a series of 471 cases.…”

An analysis of the consequences of acute appendicitis between urban and rural patients in Bangladesh

“…Although it has been reported that the incidence of appendicitis is lower in developing countries than those in developed countries, the incidence of complications and fatal outcome is higher than in developed countries (Yang et al, 2015). Multiple studies revealed that nonperforated appendicitis incidence was highest among adolescents and adults (Boland et al, 2021;Humes & Simpson, 2006;Körner et al, 1997). On the contrary, perforated appendicitis had a higher incidence rate in small children and the elderly, irrespective of gender.…”