Focus on identifying and closing knowledge gaps in acute appendicitis

Kurihara, Hayato; Tilsed, Jonathan

doi:10.1007/s00068-022-02209-1

Cited by 1 publication

(1 citation statement)

References 34 publications

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“…In the current literature, there are numerous knowledge gaps that exist in the management of acute appendicitis. These include decisions on management (surgical versus non-surgical), optimal timing of appendectomy, indications and timing of interval appendectomy (IA), pre-operative medicine, type of surgical intervention in high-risk populations (open versus laparoscopic), intra-operative techniques, post-operative antibiotics, and the need for drain placement [ 11 ]. Our updated review aims to address current treatment approach and knowledge gaps associated with the management of appendicitis, providing an in-depth evidence-informed analysis of the myriad of intra- and perioperative treatment modalities as well as the strategies currently in use and their appropriate indications.…”

Section: Introductionmentioning

confidence: 99%

Controversies and Future Directions in Management of Acute Appendicitis: An Updated Comprehensive Review

Dahiya,

Akram,

Goyal

et al. 2024

JCM

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Globally, acute appendicitis has an estimated lifetime risk of 7–8%. However, there are numerous controversies surrounding the management of acute appendicitis, and the best treatment approach depends on patient characteristics. Non-operative management (NOM), which involves the utilization of antibiotics and aggressive intravenous hydration, and surgical appendectomy are valid treatment options for healthy adults. NOM is also ideal for poor surgical candidates. Another important consideration is the timing of surgery, i.e., the role of interval appendectomy (IA) and the possibility of delaying surgery for a few hours on index admission. IA refers to surgical removal of the appendix 8–12 weeks after the initial diagnosis of appendicitis. It is ideal in patients with a contained appendiceal perforation on initial presentation, wherein an initial nonoperative approach is preferred. Furthermore, IA can help distinguish malignant and non-malignant causes of acute appendicitis, while reducing the risk of recurrence. On the contrary, a decision to delay appendectomy for a few hours on index admission should be made based on the patients’ baseline health status and severity of appendicitis. Post-operatively, surgical drain placement may help reduce postoperative complications; however, it carries an increased risk of drain occlusion, fistula formation, and paralytic ileus. Furthermore, one of the most critical aspects of appendectomy is the closure of the appendiceal stump, which can be achieved with the help of endoclips, sutures, staples, and endoloops. In this review, we discuss different aspects of management of acute appendicitis, current controversies in management, and the potential role of endoscopic appendectomy as a future treatment option.

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Section: Introductionmentioning

confidence: 99%