Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Salomone Di Saverio, Mauro Podda, Belinda De Simone, Marco Ceresoli, Goran Augustin, Alice Gori, Marja Boermeester, Massimo Sartelli, Federico Coccolini, Antonio Tarasconi, Nicola De' Angelis, Dieter G Weber, Matti Tolonen, Arianna Birindelli, Walter Biffl, Ernest E Moore, Michael Kelly, Kjetil Soreide, Jeffry Kashuk, Richard Ten Broek, Carlos Augusto Gomes, Michael Sugrue, Richard Justin Davies, Dimitrios Damaskos, Ari Leppäniemi, Andrew Kirkpatrick, Andrew B Peitzman, Gustavo P Fraga, Ronald V Maier, Raul Coimbra, Massimo Chiarugi, Gabriele Sganga, Adolfo Pisanu, Gian Luigi De' Angelis, Edward Tan, Harry Van Goor, Francesco Pata, Isidoro Di Carlo, Osvaldo Chiara, Andrey Litvin, Fabio C Campanile, Boris Sakakushev, Gia Tomadze, Zaza Demetrashvili, Rifat Latifi, Fakri Abu-Zidan, Oreste Romeo, Helmut Segovia-Lohse, Gianluca Baiocchi, David Costa, Sandro Rizoli, Zsolt J Balogh, Cino Bendinelli, Thomas Scalea, Rao Ivatury, George Velmahos, Roland Andersson, Yoram Kluger, Luca Ansaloni, Fausto Catena, Salomone Di Saverio, Mauro Podda, Belinda De Simone, Marco Ceresoli, Goran Augustin, Alice Gori, Marja Boermeester, Massimo Sartelli, Federico Coccolini, Antonio Tarasconi, Nicola De' Angelis, Dieter G Weber, Matti Tolonen, Arianna Birindelli, Walter Biffl, Ernest E Moore, Michael Kelly, Kjetil Soreide, Jeffry Kashuk, Richard Ten Broek, Carlos Augusto Gomes, Michael Sugrue, Richard Justin Davies, Dimitrios Damaskos, Ari Leppäniemi, Andrew Kirkpatrick, Andrew B Peitzman, Gustavo P Fraga, Ronald V Maier, Raul Coimbra, Massimo Chiarugi, Gabriele Sganga, Adolfo Pisanu, Gian Luigi De' Angelis, Edward Tan, Harry Van Goor, Francesco Pata, Isidoro Di Carlo, Osvaldo Chiara, Andrey Litvin, Fabio C Campanile, Boris Sakakushev, Gia Tomadze, Zaza Demetrashvili, Rifat Latifi, Fakri Abu-Zidan, Oreste Romeo, Helmut Segovia-Lohse, Gianluca Baiocchi, David Costa, Sandro Rizoli, Zsolt J Balogh, Cino Bendinelli, Thomas Scalea, Rao Ivatury, George Velmahos, Roland Andersson, Yoram Kluger, Luca Ansaloni, Fausto Catena

Abstract

Background and aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy.

Methods: This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients.

Conclusions: The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.

Keywords: Acute appendicitis; Adult Appendicitis Score; Alvarado score; Antibiotics; Appendectomy; Appendiceal abscess; Appendicitis diagnosis score; Appendicitis guidelines; CT scan appendicitis; Complicated appendicitis; Consensus conference; Diagnostic laparoscopy; Imaging; Jerusalem guidelines; Laparoscopic appendectomy; Non-operative management; Phlegmon.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Practical WSES algorithm for diagnosis and treatment of adult patients with suspected acute appendicitis
Fig. 2
Fig. 2
Practical WSES algorithm for diagnosis and treatment of pediatric patients with suspected acute appendicitis

References

    1. Cervellin G, Mora R, Ticinesi A, et al. Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases. Ann Transl Med. 2016;4:362.
    1. Ilves I. Seasonal variations of acute appendicitis and nonspecific abdominal pain in Finland. WJG. 2014;20:4037.
    1. Viniol A, Keunecke C, Biroga T, et al. Studies of the symptom abdominal pain--a systematic review and meta-analysis. Fam Pract. 2014;31:517–529.
    1. Bhangu A, Søreide K, Di Saverio S, et al. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015;386:1278–1287.
    1. Gomes CA, Abu-Zidan FM, Sartelli M, et al. Management of Appendicitis Globally Based on Income of Countries (MAGIC) Study. World J Surg. 2018;42:3903–3910.
    1. Livingston EH, Woodward WA, Sarosi GA, et al. Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management. Ann Surg. 2007;245:886–892.
    1. Flum DR. Acute Appendicitis — Appendectomy or the “Antibiotics First” Strategy. N Engl J Med. 2015;372:1937–1943.
    1. Andersson M, Andersson RE. The Appendicitis Inflammatory Response Score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score. World J Surg. 2008;32:1843–1849.
    1. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15:557–564.
    1. Gregory S, Kuntz K, Sainfort F, et al. Cost-effectiveness of integrating a clinical decision rule and staged imaging protocol for diagnosis of appendicitis. Value in Health. 2016;19:28–35.
    1. Sammalkorpi HE, Mentula P, Leppäniemi A. A new adult appendicitis score improves diagnostic accuracy of acute appendicitis - a prospective study. BMC Gastroenterol. 2014;14:114.
    1. Sippola S, Virtanen J, Tammilehto V, et al. The accuracy of low-dose computed tomography protocol in patients with suspected acute appendicitis: the OPTICAP study. Ann Surg. 2018;1.
    1. Addiss DG, Shaffer N, Fowler BS, et al. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132:910–925.
    1. Jaschinski T, Mosch C, Eikermann M, et al. Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses of randomised controlled trials. BMC Gastroenterol. 2015;15:48.
    1. Yu M-C, Feng Y, Wang W, et al. Is laparoscopic appendectomy feasible for complicated appendicitis ?A systematic review and meta-analysis. Int J Surg. 2017;40:187–197.
    1. Podda M, Gerardi C, Cillara N, et al. Antibiotic treatment and appendectomy for uncomplicated acute appendicitis in adults and children: a systematic review and meta-analysis. Ann Surg. 2019;270:1028–1040.
    1. Harnoss JC, Zelienka I, Probst P, et al. Antibiotics versus surgical therapy for uncomplicated appendicitis: systematic review and meta-analysis of controlled trials (PROSPERO 2015) Ann Surg. 2017;265:889–900.
    1. Sallinen V, Akl EA, You JJ, et al. Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis. Br J Surg. 2016;103:656–667.
    1. Nakhamiyayev V, Galldin L, Chiarello M, et al. Laparoscopic appendectomy is the preferred approach for appendicitis: a retrospective review of two practice patterns. Surg Endosc. 2010;24:859–864.
    1. Di Saverio S, Birindelli A, Kelly MD, et al. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg. 2016;11:34.
    1. Kim JW, Shin DW, Kim DJ, et al. Effects of Timing of Appendectomy on the Risks of Perforation and Postoperative Complications of Acute Appendicitis. World J Surg. 2018;42:1295–1303.
    1. van Dijk ST, van Dijk AH, Dijkgraaf MG, et al. Meta-analysis of in-hospital delay before surgery as a risk factor for complications in patients with acute appendicitis: In-hospital delay before surgery and complications after appendicectomy. Br J Surg. 2018;105:933–945.
    1. Hall NJ, Jones CE, Eaton S, et al. Is interval appendicectomy justified after successful nonoperative treatment of an appendix mass in children? A systematic review. J Pediatr Surg. 2011;46:767–771.
    1. Senekjian L, Nirula R, Bellows B, et al. Interval appendectomy: finding the breaking point for cost-effectiveness. J Am Coll Surg. 2016;223:632–643.
    1. Guyatt GH. Going from evidence to recommendations. BMJ. 2008;336 /bmj/336/7658/0.3.atom.
    1. Brożek JL, Akl EA, Compalati E, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines Part 3 of 3. The GRADE approach to developing recommendations: GRADE: strength of recommendations in guidelines. Allergy. 2011;66:588–595.
    1. Jaeschke R, Jankowski M, Brozek J, et al. How to develop guidelines for clinical practice. Minerva Anestesiol. 2009;75:504–508.
    1. Schünemann HJ. GRADE: grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ. 2008;336:/bmj/336/7654/0.3.atom.
    1. Andersson M, Kolodziej B, Andersson RE, et al. Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis: Appendicitis Inflammatory Response score-based management of suspected appendicitis. Br J Surg. 2017;104:1451–1461.
    1. Kularatna M, Lauti M, Haran C, et al. Clinical prediction rules for appendicitis in adults: which is best? World J Surg. 2017;41:1769–1781.
    1. Coleman JJ, Carr BW, Rogers T, et al. The Alvarado score should be used to reduce emergency department length of stay and radiation exposure in select patients with abdominal pain. J Traum Acute Care Surg. 2018;84:946–950.
    1. Sobnach S, Ede C, Van Der Linde G, et al. A retrospective evaluation of the Modified Alvarado Score for the diagnosis of acute appendicitis in HIV-infected patients. Eur J Trauma Emerg Surg. 2018;44:259–263.
    1. Deiters A, Drozd A, Parikh P, et al. Use of the Alvarado score in elderly patients with complicated and uncomplicated appendicitis. Am Surg. 2019;85:397–402.
    1. Malik MU, Connelly TM, Awan F, et al. The RIPASA score is sensitive and specific for the diagnosis of acute appendicitis in a western population. Int J Colorectal Dis. 2017;32:491–497.
    1. Sammalkorpi HE, Mentula P, Savolainen H, et al. The introduction of Adult Appendicitis Score reduced negative appendectomy rate. Scand J Surg. 2017;106:196–201.
    1. Tan WJ, Acharyya S, Goh YC, et al. Prospective comparison of the Alvarado score and CT scan in the evaluation of suspected appendicitis: a proposed algorithm to guide CT use. J Am Coll Surg. 2015;220:218–224.
    1. Theilen L, Mellnick V, Shanks A, et al. Acute appendicitis in pregnancy: predictive clinical factors and pregnancy outcomes. Amer J Perinatol. 2016;34:523–528.
    1. Andersen B, Nielsen TF. Appendicitis in pregnancy: diagnosis, management and complications. Acta Obstet Gynecol Scand. 1999;78:758–762.
    1. Maslovitz S, Gutman G, Lessing JB, et al. The significance of clinical signs and blood indices for the diagnosis of appendicitis during pregnancy. Gynecol Obstet Invest. 2003;56:188–191.
    1. RIFT Study Group on behalf of the West Midlands Research Collaborative. Evaluation of appendicitis risk prediction models in adults with suspected appendicitis: Identifying adults at low risk of appendicitis. Br J Surg. Epub ahead of print December 3, 2019. 10.1002/bjs.11440.
    1. Tatli F, Yucel Y, Gozeneli O, et al. The Alvarado Score is accurate in pregnancy: a retrospective case–control study. Eur J Trauma Emerg Surg. 2019;45:411–416.
    1. Maimaiti A, Aierkin A, Mahmood KM, et al. Laparoscopic appendectomy in pregnancy with acute appendicitis: single center experience with world review. Surg Laparosc Endosc Percutan Tech. 2017;27:460–464.
    1. Atema JJ, van Rossem CC, Leeuwenburgh MM, et al. Scoring system to distinguish uncomplicated from complicated acute appendicitis. Br J Surg. 2015;102:979–990.
    1. Kulik DM, Uleryk EM, Maguire JL. Does this child have appendicitis? A systematic review of clinical prediction rules for children with acute abdominal pain. J Clin Epidemiol. 2013;66:95–104.
    1. Song CW, Kang JW, Kim JY. Different clinical features and lower scores in clinical scoring systems for appendicitis in preschool children: comparison with school age onset. Pediatr Gastroenterol Hepatol Nutr. 2018;21:51.
    1. Macco S, Vrouenraets BC, de Castro SMM. Evaluation of scoring systems in predicting acute appendicitis in children. Surgery. 2016;160:1599–1604.
    1. Scheller RL, Depinet HE, Ho ML, et al. Utility of pediatric appendicitis score in female adolescent patients. Acad Emerg Med. 2016;23:610–615.
    1. Benito J, Fernandez S, Gendive M, et al. A new clinical score to identify children at low risk for appendicitis. Am J Emerg Med. 2019;S0735675719303614.
    1. Bonadio W, Shahid S, Vardi L, et al. A pre-operative clinical scoring system to distinguish perforation risk with pediatric appendicitis. J Pediatric Surg. 2018;53:441–445.
    1. Chung PHY, Dai K, Yang Z, et al. Validity of Alvarado Score in predicting disease severity and postoperative complication in pediatric acute appendicitis. World Jnl Ped Surgery. 2019;2:e000003.
    1. Huckins DS, Copeland K, Self W, et al. Diagnostic performance of a biomarker panel as a negative predictor for acute appendicitis in adult ED patients with abdominal pain. Am J Emerg Med. 2017;35:418–424.
    1. Msolli MA, Beltaief K, Bouida W, et al. Value of early change of serum C reactive protein combined to modified Alvarado score in the diagnosis of acute appendicitis. BMC Emerg Med. 2018;18:15.
    1. Kılıç MÖ, Güldoğan CE, Balamir İ, et al. Ischemia-modified albumin as a predictor of the severity of acute appendicitis. Am J Emerg Med. 2017;35:92–95.
    1. Reddy SB, Kelleher M, Bokhari SAJ, et al. A highly sensitive and specific combined clinical and sonographic score to diagnose appendicitis. J Traum Acute Care Surg. 2017;83:643–649.
    1. Benito J, Acedo Y, Medrano L, et al. Usefulness of new and traditional serum biomarkers in children with suspected appendicitis. Am J Emerg Med. 2016;34:871–876.
    1. Depinet H, Copeland K, Gogain J, et al. Addition of a biomarker panel to a clinical score to identify patients at low risk for appendicitis. Am J Emerg Med. 2016;34:2266–2271.
    1. Zouari M, Louati H, Abid I, et al. C-reactive protein value is a strong predictor of acute appendicitis in young children. Am J Emerg Med. 2018;36:1319–1320.
    1. Yu C-W, Juan L-I, Wu M-H, et al. Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg. 2013;100:322–329.
    1. Cui W, Liu H, Ni H, et al. Diagnostic accuracy of procalcitonin for overall and complicated acute appendicitis in children: a meta-analysis. Ital J Pediatr. 2019;45:78.
    1. Zani A, Teague WJ, Clarke SA, et al. Can common serum biomarkers predict complicated appendicitis in children? Pediatr Surg Int. 2017;33:799–805.
    1. Lima M, Persichetti-Proietti D, Di Salvo N, et al. The APpendicitis PEdiatric (APPE) score: a new diagnostic tool in suspected pediatric acute appendicitis. Pediatr Med Chir. 41. Epub ahead of print April 2, 2019. 10.4081/pmc.2019.209.
    1. Salö M, Marungruang N, Roth B, et al. Evaluation of the microbiome in children’s appendicitis. Int J Colorectal Dis. 2017;32:19–28.
    1. Yap T-L, Fan JD, Chen Y, et al. A novel noninvasive appendicitis score with a urine biomarker. J Pediatric Surg. 2019;54:91–96.
    1. Scott AJ, Mason SE, Arunakirinathan M, et al. Risk stratification by the Appendicitis Inflammatory Response score to guide decision-making in patients with suspected appendicitis. Br J Surg. 2015;102:563–572.
    1. Chang ST, Jeffrey RB, Olcott EW. Three-step sequential positioning algorithm during sonographic evaluation for appendicitis increases appendiceal visualization rate and reduces CT use. Am J Roentgenol. 2014;203:1006–1012.
    1. Matthew Fields J, Davis J, Alsup C, et al. Accuracy of point-of-care ultrasonography for diagnosing acute appendicitis: a systematic review and meta-analysis. Acad Emerg Med. 2017;24:1124–1136.
    1. Sola R, Theut SB, Sinclair KA, et al. Standardized reporting of appendicitis-related findings improves reliability of ultrasound in diagnosing appendicitis in children. J Pediatric Surg. 2018;53:984–987.
    1. Kim HJ, Jeon BG, Hong CK, et al. Low-dose CT for the diagnosis of appendicitis in adolescents and young adults (LOCAT): a pragmatic, multicentre, randomised controlled non-inferiority trial. Lancet Gastroenterol Hepatol. 2017;2:793–804.
    1. Rud B, Olafsson L, Vejborg TS, et al. Diagnostic accuracy of computed tomography for appendicitis in adults. Cochrane Database Syst Rev. Epub ahead of print 2019. 10.1002/14651858.CD009977.
    1. Gaskill CE, Simianu VV, Carnell J, et al. Use of computed tomography to determine perforation in patients with acute appendicitis. Curr Prob Diagnostic Radiol. 2018;47:6–9.
    1. Kim MS, Kwon H-J, Kang KA, et al. Diagnostic performance and useful findings of ultrasound re-evaluation for patients with equivocal CT features of acute appendicitis. Br J Radiol. 2018;91:20170529.
    1. Garcia EM, Camacho MA, Karolyi DR, et al. ACR Appropriateness Criteria® Right Lower Quadrant Pain-Suspected Appendicitis. J Am Coll Radiol. 2018;15:S373–S387.
    1. Amitai MM, Katorza E, Guranda L, et al. Role of emergency magnetic resonance imaging for the workup of suspected appendicitis in pregnant women. Isr Med Assoc J. 2016;18:600–604.
    1. Segev L, Segev Y, Rayman S, et al. The diagnostic performance of ultrasound for acute appendicitis in pregnant and young nonpregnant women: a case-control study. Int J Surg. 2016;34:81–85.
    1. Lehnert BE, Gross JA, Linnau KF, et al. Utility of ultrasound for evaluating the appendix during the second and third trimester of pregnancy. Emerg Radiol. 2012;19:293–299.
    1. Baruch Y, Canetti M, Blecher Y, et al. The diagnostic accuracy of ultrasound in the diagnosis of acute appendicitis in pregnancy. J Mater Fetal Neonat Med. 2019:1–6.
    1. Blumenfeld YJ, Wong AE, Jafari A, et al. MR imaging in cases of antenatal suspected appendicitis – a meta-analysis. J Mate Fetal Neonat Med. 2011;24:485–488.
    1. Duke E, Kalb B, Arif-Tiwari H, et al. A systematic review and meta-analysis of diagnostic performance of MRI for evaluation of acute appendicitis. Am J Roentgenol. 2016;206:508–517.
    1. Burns M, Hague CJ, Vos P, et al. Utility of magnetic resonance imaging for the diagnosis of appendicitis during pregnancy: a Canadian experience. Can Assoc Radiol J. 2017;68:392–400.
    1. Burke LMB, Bashir MR, Miller FH, et al. Magnetic resonance imaging of acute appendicitis in pregnancy: a 5-year multiinstitutional study. Am J Obstet Gynecol. 2015;213:693.e1–693.e6.
    1. Theilen LH, Mellnick VM, Longman RE, et al. Utility of magnetic resonance imaging for suspected appendicitis in pregnant women. Am J Obstet Gynecol. 2015;212:345.e1–345.e6.
    1. Al-Katib S, Sokhandon F, Farah M. MRI for appendicitis in pregnancy: is seeing believing? clinical outcomes in cases of appendix nonvisualization. Abdom Radiol (NY). 2016;41:2455–2459.
    1. Patel D, Fingard J, Winters S, et al. Clinical use of MRI for the evaluation of acute appendicitis during pregnancy. Abdom Radiol. 2017;42:1857–1863.
    1. Ziedses des Plantes CMP, van Veen MJF, van der Palen J, et al. The effect of unenhanced MRI on the surgeons’ decision-making process in females with suspected appendicitis. World J Surg. 2016;40:2881–2887.
    1. Koberlein GC, Trout AT, Rigsby CK, et al. ACR Appropriateness Criteria® Suspected Appendicitis-Child. J Am Coll Radiol. 2019;16:S252–S263.
    1. Love BE, Camelo M, Nouri S, et al. Ultrasound accuracy in diagnosing appendicitis in obese pediatric patients. Am Surg. 2017;83:1063–1067.
    1. Gonzalez DO, Lawrence AE, Cooper JN, et al. Can ultrasound reliably identify complicated appendicitis in children? J Surg Res. 2018;229:76–81.
    1. Bachur RG, Levy JA, Callahan MJ, et al. Effect of Reduction in the use of computed tomography on clinical outcomes of appendicitis. JAMA Pediatr. 2015;169:755.
    1. Shah SR, Sinclair KA, Theut SB, et al. Computed tomography utilization for the diagnosis of acute appendicitis in children decreases with a diagnostic algorithm. Ann Surg. 2016;264:474–481.
    1. Dibble EH, Swenson DW, Cartagena C, et al. Effectiveness of a staged US and unenhanced MR imaging algorithm in the diagnosis of pediatric appendicitis. Radiology. 2018;286:1022–1029.
    1. Fallon SC, Orth RC, Guillerman RP, et al. Development and validation of an ultrasound scoring system for children with suspected acute appendicitis. Pediatr Radiol. 2015;45:1945–1952.
    1. Hwang ME. Sonography and computed tomography in diagnosing acute appendicitis. Radiol Technol. 2018;89:224–237.
    1. Zhang H, Liao M, Chen J, et al. Ultrasound, computed tomography or magnetic resonance imaging - which is preferred for acute appendicitis in children? A Meta-analysis. Pediatr Radiol. 2017;47:186–196.
    1. Lee J, Ko Y, Ahn S, et al. Comparison of US and CT on the effect on negative appendectomy and appendiceal perforation in adolescents and adults: a post-hoc analysis using propensity-score methods: US Versus CT Using Propensity-Score Methods. J Clin Ultrasound. 2016;44:401–410.
    1. Yi DY, Lee KH, Park SB, et al. Accuracy of low dose CT in the diagnosis of appendicitis in childhood and comparison with USG and standard dose CT. J Pediatria. 2017;93:625–631.
    1. Rosenbaum DG, Askin G, Beneck DM, et al. Differentiating perforated from non-perforated appendicitis on contrast-enhanced magnetic resonance imaging. Pediatr Radiol. 2017;47:1483–1490.
    1. Moore MM, Kulaylat AN, Hollenbeak CS, et al. Magnetic resonance imaging in pediatric appendicitis: a systematic review. Pediatr Radiol. 2016;46:928–939.
    1. Kinner S, Pickhardt PJ, Riedesel EL, et al. Diagnostic accuracy of MRI versus CT for the evaluation of acute appendicitis in children and young adults. Am J Roentgenol. 2017;209:911–919.
    1. Eng KA, Abadeh A, Ligocki C, et al. Acute appendicitis: a meta-analysis of the diagnostic accuracy of US, CT, and MRI as second-line imaging tests after an initial US. Radiology. 2018;288:717–727.
    1. Huston JM, Kao LS, Chang PK, et al. Antibiotics vs. appendectomy for acute uncomplicated appendicitis in adults: review of the evidence and future directions. Surg Infect. 2017;18:527–535.
    1. Hansson J, Khorram-Manesh A, Alwindawe A, et al. A model to select patients who may benefit from antibiotic therapy as the first line treatment of acute appendicitis at high probability. J Gastrointest Surg. 2014;18:961–967.
    1. Loftus TJ, Brakenridge SC, Croft CA, et al. Successful nonoperative management of uncomplicated appendicitis: predictors and outcomes. J Surg Res. 2018;222:212–218.e2.
    1. Salminen P, Paajanen H, Rautio T, et al. Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. JAMA. 2015;313:2340.
    1. Salminen P, Tuominen R, Paajanen H, et al. Five-year follow-up of antibiotic therapy for uncomplicated acute appendicitis in the APPAC randomized clinical trial. JAMA. 2018;320:1259.
    1. Sippola S, Grönroos J, Tuominen R, et al. Economic evaluation of antibiotic therapy versus appendicectomy for the treatment of uncomplicated acute appendicitis from the APPAC randomized clinical trial: economic evaluation of antibiotic therapy versus appendicectomy for uncomplicated acute appendicitis. Br J Surg. 2017;104:1355–1361.
    1. Vons C, Barry C, Maitre S, et al. Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. Lancet. 2011;377:1573–1579.
    1. Singh JP, Mariadason JG. Role of the faecolith in modern-day appendicitis. Ann R Coll Surg Engl. 2013;95:48–51.
    1. Mällinen J, Vaarala S, Mäkinen M, et al. Appendicolith appendicitis is clinically complicated acute appendicitis—is it histopathologically different from uncomplicated acute appendicitis. Int J Colorectal Dis. 2019;34:1393–1400.
    1. Dalsgaard Jensen T, Penninga L. Appendicitis during pregnancy in a Greenlandic Inuit woman; antibiotic treatment as a bridge-to-surgery in a remote area. BMJ Case Rep. 2016:bcr2016214722.
    1. Carstens A-K, Fensby L, Penninga L. Nonoperative treatment of appendicitis during pregnancy in a remote area. AJP Rep. 2018;08:e37–e38.
    1. Joo JI, Park H-C, Kim MJ, et al. Outcomes of antibiotic therapy for uncomplicated appendicitis in pregnancy. Am J Med. 2017;130:1467–1469.
    1. Omling E, Salö M, Saluja S, et al. Nationwide study of appendicitis in children. Br J Surg. 2019;106:1623–1631.
    1. Georgiou R, Eaton S, Stanton MP, et al. Efficacy and safety of nonoperative treatment for acute appendicitis: a meta-analysis. Pediatrics. 2017;139:e20163003.
    1. Minneci PC, Mahida JB, Lodwick DL, et al. Effectiveness of patient choice in nonoperative vs surgical management of pediatric uncomplicated acute appendicitis. JAMA Surg. 2016;151:408.
    1. Xu J, Adams S, Liu YC, et al. Nonoperative management in children with early acute appendicitis: A systematic review. J Pediatric Surg. 2017;52:1409–1415.
    1. Huang L, Yin Y, Yang L, et al. Comparison of antibiotic therapy and appendectomy for acute uncomplicated appendicitis in children: a meta-analysis. JAMA Pediatr. 2017;171:426.
    1. Mahida JB, Lodwick DL, Nacion KM, et al. High failure rate of nonoperative management of acute appendicitis with an appendicolith in children. J Pediatric Surg. 2016;51:908–911.
    1. Svensson JF, Patkova B, Almström M, et al. Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial. Ann Surg. 2015;261:67–71.
    1. Tanaka Y, Uchida H, Kawashima H, et al. Long-term outcomes of operative versus nonoperative treatment for uncomplicated appendicitis. J Pediatric Surg. 2015;50:1893–1897.
    1. Lee SL, Spence L, Mock K, et al. Expanding the inclusion criteria for non-operative management of uncomplicated appendicitis: Outcomes and cost. J Pediatric Surg. 2018;53:42–47.
    1. Gorter RR, The S-MML. Gorter-Stam MAW, et al. Systematic review of nonoperative versus operative treatment of uncomplicated appendicitis. J Pediatric Surg. 2017;52:1219–1227.
    1. Kessler U, Mosbahi S, Walker B, et al. Conservative treatment versus surgery for uncomplicated appendicitis in children: a systematic review and meta-analysis. Arch Dis Child. 2017;102:1118–1124.
    1. Podda M, Cillara N, Di Saverio S, et al. Antibiotics-first strategy for uncomplicated acute appendicitis in adults is associated with increased rates of peritonitis at surgery. A systematic review with meta-analysis of randomized controlled trials comparing appendectomy and non-operative management with antibiotics. Surgeon. 2017;15:303–314.
    1. Sartelli M, Chichom-Mefire A, Labricciosa FM, et al. The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2017;12:29.
    1. on behalf of the APPAC study group. Haijanen J, Sippola S, et al. Optimising the antibiotic treatment of uncomplicated acute appendicitis: a protocol for a multicentre randomised clinical trial (APPAC II trial) BMC Surg. 2018;18:117.
    1. Park HC, Kim MJ, Lee BH. Randomized clinical trial of antibiotic therapy for uncomplicated appendicitis: Antibiotic therapy for uncomplicated appendicitis. Br J Surg. 2017;104:1785–1790.
    1. Sippola S, Grönroos J, Sallinen V, et al. A randomised placebo-controlled double-blind multicentre trial comparing antibiotic therapy with placebo in the treatment of uncomplicated acute appendicitis: APPAC III trial study protocol. BMJ Open. 2018;8:e023623.
    1. Alore EA, Ward JL, Todd SR, et al. Population-level outcomes of early versus delayed appendectomy for acute appendicitis using the American College of Surgeons National Surgical Quality Improvement Program. J Surg Res. 2018;229:234–242.
    1. Elniel M, Grainger J, Nevins EJ, et al. 72 h Is the time critical point to operate in acute appendicitis. J Gastrointest Surg. 2018;22:310–315.
    1. Tankel J, Yellinek S, Shechter Y, et al. Delaying laparoscopic surgery in pregnant patients with an equivocal acute appendicitis: a step-wise approach does not affect maternal or fetal safety. Surg Endosc. 2019;33:2960–2966.
    1. Serres SK, Cameron DB, Glass CC, et al. Time to appendectomy and risk of complicated appendicitis and adverse outcomes in children. JAMA Pediatr. 2017;171:740.
    1. Almström M, Svensson JF, Patkova B, et al. In-hospital surgical delay does not increase the risk for perforated appendicitis in children: a single-center retrospective cohort study. Ann Surg. 2017;265:616–621.
    1. Boomer LA, Cooper JN, Anandalwar S, et al. Delaying appendectomy does not lead to higher rates of surgical site infections: a multi-institutional analysis of children with appendicitis. Ann Surg. 2016;264:164–168.
    1. Gurien LA, Wyrick DL, Smith SD, et al. Optimal timing of appendectomy in the pediatric population. J Surg Res. 2016;202:126–131.
    1. Cameron DB, Williams R, Geng Y, et al. Time to appendectomy for acute appendicitis: a systematic review. J Pediatric Surg. 2018;53:396–405.
    1. Saluja S, Sun T, Mao J, et al. Early versus late surgical management of complicated appendicitis in children: a statewide database analysis with one-year follow-up. J Pediatric Surg. 2018;53:1339–1344.
    1. Li X, Zhang J, Sang L, et al. Laparoscopic versus conventional appendectomy - a meta-analysis of randomized controlled trials. BMC Gastroenterol. 2010;10:129.
    1. Wei B, Qi C-L, Chen T-F, et al. Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis. Surg Endosc. 2011;25:1199–1208.
    1. Jaschinski T, Sauerland S, Lefering R, et al. Laparoscopic versus open surgery for suspected appendicitis. In: The Cochrane Collaboration, editor. The Cochrane Database of Systematic Reviews. Chichester: Wiley. p. CD001546.
    1. Ukai T, Shikata S, Takeda H, et al. Evidence of surgical outcomes fluctuates over time: results from a cumulative meta-analysis of laparoscopic versus open appendectomy for acute appendicitis. BMC Gastroenterol. 2016;16:37.
    1. Athanasiou CD, Robinson J, Yiasemidou M, et al. Laparoscopic vs open approach for transverse colon cancer. A systematic review and meta-analysis of short and long term outcomes. Int J Surg. 2017;41:78–85.
    1. Zhang S, Du T, Jiang X, et al. Laparoscopic appendectomy in children with perforated appendicitis: a meta-analysis. Surg Laparos Endo Percutaneous Techniques. 2017;27:262–266.
    1. Xue C, Lin B, Huang Z, et al. Single-incision laparoscopic appendectomy versus conventional 3-port laparoscopic appendectomy for appendicitis: an updated meta-analysis of randomized controlled trials. Surg Today. 2015;45:1179–1186.
    1. Aly OE, Black DH, Rehman H, et al. Single incision laparoscopic appendicectomy versus conventional three-port laparoscopic appendicectomy: a systematic review and meta-analysis. Int J Surg. 2016;35:120–128.
    1. Moriguchi T, Machigashira S, Sugita K, et al. A randomized trial to compare the conventional three-port laparoscopic appendectomy procedure to single-incision and one-puncture procedure that was safe and feasible, even for surgeons in training. J Laparoendosc Adv Surg Tech A. 2019;29:392–395.
    1. Golebiewski A, Anzelewicz S, Wiejek A, et al. A prospective randomized controlled trial of single-port and three-port laparoscopic appendectomy in children. J Laparoendosc Adv Surg Tech. 2019;29:703–709.
    1. Zhang Z, Wang Y, Liu R, et al. Systematic review and meta-analysis of single-incision versus conventional laparoscopic appendectomy in children. J Pediatric Surg. 2015;50:1600–1609.
    1. Karam PA, Mohan A, Buta MR, et al. Comparison of transumbilical laparoscopically assisted appendectomy to conventional laparoscopic appendectomy in children. Surg Laparosc Endosc Percutan Tech. 2016;26:508–512.
    1. Sekioka A, Takahashi T, Yamoto M, et al. Outcomes of transumbilical laparoscopic-assisted appendectomy and conventional laparoscopic appendectomy for acute pediatric appendicitis in a single institution. J Laparoendosc Adv Surg Tech. 2018;28:1548–1552.
    1. Scott A, Shekherdimian S, Rouch JD, et al. Same-day discharge in laparoscopic acute non-perforated appendectomy. J Am Coll Surg. 2017;224:43–48.
    1. Frazee RC, Abernathy SW, Isbell CL, et al. Outpatient laparoscopic appendectomy: is it time to end the discussion? J Am Coll Surg. 2016;222:473–477.
    1. Trejo-Ávila ME, Romero-Loera S, Cárdenas-Lailson E, et al. Enhanced recovery after surgery protocol allows ambulatory laparoscopic appendectomy in uncomplicated acute appendicitis: a prospective, randomized trial. Surg Endosc. 2019;33:429–436.
    1. Werkgartner G, Cerwenka H, El Shabrawi A, et al. Laparoscopic versus open appendectomy for complicated appendicitis in high risk patients. Int J Colorectal Dis. 2015;30:397–401.
    1. Wang D, Dong T, Shao Y, et al. Laparoscopy versus open appendectomy for elderly patients, a meta-analysis and systematic review. BMC Surg. 2019;19:54.
    1. Michailidou M, Sacco Casamassima MG, Goldstein SD, et al. The impact of obesity on laparoscopic appendectomy: Results from the ACS National Surgical Quality Improvement Program pediatric database. J Pediatric Surg. 2015;50:1880–1884.
    1. Dasari BVM, Baker J, Markar S, et al. Laparoscopic appendicectomy in obese is associated with improvements in clinical outcome: systematic review. Int J Surg. 2015;13:250–256.
    1. Lee SH, Lee JY, Choi YY, et al. Laparoscopic appendectomy versus open appendectomy for suspected appendicitis during pregnancy: a systematic review and updated meta-analysis. BMC Surg. 2019;19:41.
    1. Siotos C, Stergios K, Prasath V, et al. Irrigation versus suction in laparoscopic appendectomy for complicated appendicitis: a meta-analysis. J Surg Res. 2019;235:237–243.
    1. Hajibandeh S, Hajibandeh S, Kelly A, et al. Irrigation versus suction alone in laparoscopic appendectomy: is dilution the solution to pollution? A systematic review and meta-analysis. Surg Innov. 2018;25:174–182.
    1. Yang H-R, Wang Y-C, Chung P-K, et al. Laparoscopic appendectomy using the LigaSure Vessel Sealing System. J Laparoendosc Adv Surg Tech A. 2005;15:353–356.
    1. Sucullu I, Filiz AI, Kurt Y, et al. The effects of LigaSure on the laparoscopic management of acute appendicitis: “LigaSure assisted laparoscopic appendectomy.”. Surg Laparosc Endosc Percutan Tech. 2009;19:333–335.
    1. Diamantis T, Kontos M, Arvelakis A, et al. Comparison of monopolar electrocoagulation, bipolar electrocoagulation, Ultracision, and Ligasure. Surg Today. 2006;36:908–913.
    1. Pogorelić Z, Katić J, Mrklić I, et al. Lateral thermal damage of mesoappendix and appendiceal base during laparoscopic appendectomy in children: comparison of the harmonic scalpel (Ultracision), bipolar coagulation (LigaSure), and thermal fusion technology (MiSeal) J Surg Res. 2017;212:101–107.
    1. Perrin J, Morreau P, Upadhyay V. Is hook diathermy safe to dissect the mesoappendix in paediatric patients? A 10-year experience. N Z Med J. 2019;132:41–47.
    1. Wright GP, Mitchell EJ, McClure AM, et al. Comparison of stapling techniques and management of the mesoappendix in laparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech. 2015;25:e11–e15.
    1. Swank HA, van Rossem CC, van Geloven AAW, et al. Endostapler or endoloops for securing the appendiceal stump in laparoscopic appendectomy: a retrospective cohort study. Surg Endosc. 2014;28:576–583.
    1. Al-Temimi MH, Berglin MA, Kim EG, et al. Endostapler versus Hem-O-Lok clip to secure the appendiceal stump and mesoappendix during laparoscopic appendectomy. Am J Surg. 2017;214:1143–1148.
    1. On behalf of the snapshot appendicitis collaborative study group. van Rossem CC, van Geloven AAW, et al. Endoloops or endostapler use in laparoscopic appendectomy for acute uncomplicated and complicated appendicitis: no difference in infectious complications. Surg Endosc. 2017;31:178–184.
    1. Ceresoli M, Tamini N, Gianotti L, et al. Are endoscopic loop ties safe even in complicated acute appendicitis? A systematic review and meta-analysis. Int J Surg. 2019;68:40–47.
    1. Mannu GS, Sudul MK, Bettencourt-Silva JH, et al. Closure methods of the appendix stump for complications during laparoscopic appendectomy. Cochrane Database Syst Rev. 2017;11:CD006437.
    1. Antoniou SA, Mavridis D, Hajibandeh S, et al. Optimal stump management in laparoscopic appendectomy: A network meta-analysis by the Minimally Invasive Surgery Synthesis of Interventions and Outcomes Network. Surgery. 2017;162:994–1005.
    1. Knight SR, Ibrahim A, Makaram N, et al. The use of polymeric clips in securing the appendiceal stump during laparoscopic appendicectomy: a systematic review. Eur J Trauma Emerg Surg. 2019;45:665–670.
    1. Qian D, He Z, Hua J, et al. Stump invagination versus simple ligation in open appendicectomy: a systematic review and meta-analysis. Int Surg. 2015;100:1199–1206.
    1. Li Z, Zhao L, Cheng Y, et al. Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. Cochrane Database Syst Rev. 2018;5:CD010168.
    1. Allemann P, Probst H, Demartines N, et al. Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis—the role of routine abdominal drainage. Langenbecks Arch Surg. 2011;396:63–68.
    1. Schlottmann F, Reino R, Sadava EE, et al. Could an abdominal drainage be avoided in complicated acute appendicitis? Lessons learned after 1300 laparoscopic appendectomies. Int J Surg. 2016;36:40–43.
    1. Aneiros Castro B, Cano I, García A, et al. Abdominal drainage after laparoscopic appendectomy in children: an endless controversy? Scand J Surg. 2018;107:197–200.
    1. Mihaljevic AL, Müller TC, Kehl V, et al. Wound edge protectors in open abdominal surgery to reduce surgical site infections: a systematic review and meta-analysis. PLoS One. 2015;10:e0121187.
    1. Ahmed K, Connelly TM, Bashar K, et al. Are wound ring protectors effective in reducing surgical site infection post appendectomy? A systematic review and meta-analysis. Ir J Med Sci. 2016;185:35–42.
    1. Siribumrungwong B, Chantip A, Noorit P, et al. Comparison of superficial surgical site infection between delayed primary versus primary wound closure in complicated appendicitis: a randomized controlled trial. Ann Surg. 2018;267:631–637.
    1. Andrade LAM, Muñoz FYP, Báez MVJ, et al. Appendectomy skin closure technique, randomized controlled trial: changing paradigms (ASC) World J Surg. 2016;40:2603–2610.
    1. Strong S, Blencowe N, Bhangu A. How good are surgeons at identifying appendicitis? Results from a multi-centre cohort study. Int J Surg. 2015;15:107–112.
    1. van den Boom AL, de Wijkerslooth EML, Mauff KAL, et al. Interobserver variability in the classification of appendicitis during laparoscopy: Interobserver variability in classification of appendicitis during laparoscopy. Br J Surg. 2018;105:1014–1019.
    1. de Wijkerslooth EML, van den Boom AL, Wijnhoven BPL. Variation in classification and postoperative management of complex appendicitis: a European survey. World J Surg. 2019;43:439–446.
    1. Hamminga JTH, Hofker HS, Broens PMA, et al. Evaluation of the appendix during diagnostic laparoscopy, the laparoscopic appendicitis score: a pilot study. Surg Endosc. 2013;27:1594–1600.
    1. Gomes CA, Sartelli M, Di Saverio S, et al. Acute appendicitis: proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings. World J Emerg Surg. 2015;10:60.
    1. Sartelli M, Baiocchi GL, Di Saverio S, et al. Prospective observational study on acute appendicitis worldwide (POSAW) World J Emerg Surg. 2018;13:19.
    1. Shafi S, Aboutanos M, Brown CV-R, et al. Measuring anatomic severity of disease in emergency general surgery. J Trauma Acute Care Surg. 2014;76:884–887.
    1. Hernandez MC, Aho JM, Habermann EB, et al. Increased anatomic severity predicts outcomes: Validation of the American Association for the Surgery of Traumaʼs Emergency General Surgery score in appendicitis. J Trauma and Acute Care Surg. 2017;82:73–79.
    1. Hernandez MC, Polites SF, Aho JM, et al. Measuring anatomic severity in pediatric appendicitis: validation of the american association for the surgery of trauma appendicitis severity grade. J Pediatrics. 2018;192:229–233.
    1. Finnesgard EJ, Hernandez MC, Aho JM, et al. The American Association for the Surgery of Trauma Emergency General Surgery Anatomic Severity Scoring System as a predictor of cost in appendicitis. Surg Endosc. 2018;32:4798–4804.
    1. Reid F, Choi J, Williams M, et al. Prospective evaluation of the Sunshine Appendicitis Grading System score: Sunshine Appendicitis Grading System score. ANZ J Surg. 2017;87:368–371.
    1. Farach SM, Danielson PD, Walford NE, et al. Operative Findings Are a Better Predictor of Resource Utilization in Pediatric Appendicitis. J Pediatric Surg. 2015;50:1574–1578.
    1. Korndorffer JR, Fellinger E, Reed W. SAGES guideline for laparoscopic appendectomy. Surg Endosc. 2010;24:757–761.
    1. Gorter RR, Eker HH, Gorter-Stam MAW, et al. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc. 2016;30:4668–4690.
    1. Phillips AW, Jones AE, Sargen K. Should the macroscopically normal appendix be removed during laparoscopy for acute right iliac fossa pain when no other explanatory pathology is found? Surg Laparosc Endosc Percutan Tech. 2009;19:392–394.
    1. Grimes C, Chin D, Bailey C, et al. Appendiceal faecaliths are associated with right iliac fossa pain. Annals. 2010;92:61–64.
    1. Tartaglia D, Bertolucci A, Galatioto C, et al. Incidental appendectomy? Microscopy tells another story: A retrospective cohort study in patients presenting acute right lower quadrant abdominal pain. Int J Surg. 2016;28:149–152.
    1. Sørensen AK, Bang-Nielsen A, Levic-Souzani K, et al. Readmission and reoperation rates following negative diagnostic laparoscopy for clinically suspected appendicitis: The “normal” appendix should not be removed – a retrospective cohort study. Int J Surg. 2019;64:1–4.
    1. Allaway MGR, Eslick GD, Cox MR. The unacceptable morbidity of negative laparoscopic appendicectomy. World J Surg. 2019;43:405–414.
    1. Gaitán HG, Reveiz L, Farquhar C. Laparoscopy for the management of acute lower abdominal pain in women of childbearing age. In: The Cochrane Collaboration, ed. Cochrane Database of Systematic Reviews. Chichester: Wiley. p. CD007683.
    1. Andersson RE, Petzold MG. Nonsurgical treatment of appendiceal abscess or phlegmon: a systematic review and meta-analysis. Ann Surg. 2007;246:741–748.
    1. Simillis C, Symeonides P, Shorthouse AJ, et al. A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon) Surgery. 2010;147:818–829.
    1. Horn CB, Coleoglou Centeno AA, Guerra JJ, et al. Drain failure in intra-abdominal abscesses associated with appendicitis. Surg Infect. 2018;19:321–325.
    1. Helling TS, Soltys DF, Seals S. Operative versus non-operative management in the care of patients with complicated appendicitis. Am J Surg. 2017;214:1195–1200.
    1. Young KA, Neuhaus NM, Fluck M, et al. Outcomes of complicated appendicitis: is conservative management as smooth as it seems? Am J Surg. 2018;215:586–592.
    1. Gavriilidis P, de’ Angelis N, Katsanos K, et al. Acute appendicectomy or conservative treatment for complicated appendicitis (phlegmon or abscess)? A systematic review by updated traditional and cumulative meta-analysis. J Clin Med Res. 2019;11:56–64.
    1. Cheng Y, Xiong X, Lu J, et al. Early versus delayed appendicectomy for appendiceal phlegmon or abscess. In: The Cochrane Collaboration, editor. Cochrane Database of Systematic Reviews. Chichester: Wiley. p. CD011670.
    1. Mentula P, Sammalkorpi H, Leppäniemi A. Laparoscopic surgery or conservative treatment for appendiceal abscess in adults? A randomized controlled trial. Ann Surg. 2015;262:237–242.
    1. Luo C-C, Cheng K-F, Huang C-S, et al. Therapeutic effectiveness of percutaneous drainage and factors for performing an interval appendectomy in pediatric appendiceal abscess. BMC Surg. 2016;16:72.
    1. Fugazzola P, Coccolini F, Tomasoni M, et al. Early appendectomy vs. conservative management in complicated acute appendicitis in children: a meta-analysis. J Pediatric Surg. 2019;54:2234–2241.
    1. Vaos G, Dimopoulou A, Gkioka E, et al. Immediate surgery or conservative treatment for complicated acute appendicitis in children? A meta-analysis. J Pediatric Surg. 2019;54:1365–1371.
    1. Darwazeh G, Cunningham SC, Kowdley GC. A systematic review of perforated appendicitis and phlegmon: interval appendectomy or wait-and-see? Am Surg. 2016;82:11–15.
    1. Rushing A, Bugaev N, Jones C, et al. Management of acute appendicitis in adults: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2019;87:214–224.
    1. Hall NJ, Eaton S, Stanton MP, et al. Active observation versus interval appendicectomy after successful non-operative treatment of an appendix mass in children (CHINA study): an open-label, randomised controlled trial. Lancet Gastroenterol Hepatol. 2017;2:253–260.
    1. Renteria O, Shahid Z, Huerta S. Outcomes of appendectomy in elderly veteran patients. Surgery. 2018;164:460–465.
    1. de Jonge J, Bolmers MDM, Musters GD, et al. Predictors for interval appendectomy in non-operatively treated complicated appendicitis. Int J Colorectal Dis. 2019;34:1325–1332.
    1. Mällinen J, Rautio T, Grönroos J, et al. Risk of appendiceal neoplasm in periappendicular abscess in patients treated with interval appendectomy vs follow-up with magnetic resonance imaging: 1-year outcomes of the peri–appendicitis acuta randomized clinical trial. JAMA Surg. 2019;154:200.
    1. Andersen B, Kallehave F, Andersen H. Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. In: The Cochrane Collaboration, editor. The Cochrane Database of Systematic Reviews. Chichester: Wiley. p. CD001439.
    1. Andersen BR, Kallehave FL, Andersen HK. Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Cochrane Database Syst Rev. 2005:CD001439.
    1. Wu W-T, Tai F-C, Wang P-C, et al. Surgical site infection and timing of prophylactic antibiotics for appendectomy. Surg Infect. 2014;15:781–785.
    1. Cho J, Park I, Lee D, et al. Antimicrobial treatment after laparoscopic appendectomy for preventing a post-operative intraabdominal abscess: A Prospective Cohort Study of 1817 patients. Int J Surg. 2016;27:142–146.
    1. McGillen PK, Drake FT, Vallejo A, et al. Retrospective analysis of post-operative antibiotics in complicated appendicitis. Surg Infect. 2019;20:359–366.
    1. van den Boom AL, de Wijkerslooth EML, Wijnhoven BPL. Systematic review and meta-analysis of postoperative antibiotics for patients with a complex appendicitis. Dig Surg. 2019:1–10.
    1. Saar S, Mihnovitš V, Lustenberger T, et al. Twenty-four hour versus extended antibiotic administration after surgery in complicated appendicitis: A randomized controlled trial. J Trauma Acute Care Surg. 2019;86:36–42.
    1. Sawyer RG, Claridge JA, Nathens AB, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015;372:1996–2005.
    1. Litz CN, Asuncion JB, Danielson PD, et al. Timing of antimicrobial prophylaxis and infectious complications in pediatric patients undergoing appendectomy. J Pediatric Surg. 2018;53:449–451.
    1. Lee SL, Islam S, Cassidy LD, et al. Antibiotics and appendicitis in the pediatric population: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee Systematic Review. J Pediatric Surg. 2010;45:2181–2185.
    1. Shang Q, Geng Q, Zhang X, et al. The efficacy of combined therapy with metronidazole and broad-spectrum antibiotics on postoperative outcomes for pediatric patients with perforated appendicitis. Medicine. 2017;96:e8849.
    1. Kronman MP, Oron AP, Ross RK, et al. Extended- versus narrower-spectrum antibiotics for appendicitis. Pediatrics. 2016;138:e20154547.
    1. Dreznik Y, Feigin E, Samuk I, et al. Dual versus triple antibiotics regimen in children with perforated acute appendicitis. Eur J Pediatr Surg. 2018;28:491–494.
    1. Arnold MR, Wormer BA, Kao AM, et al. Home intravenous versus oral antibiotics following appendectomy for perforated appendicitis in children: a randomized controlled trial. Pediatr Surg Int. 2018;34:1257–1268.
    1. Sujka JA, Weaver KL, Sobrino JA, et al. Efficacy of oral antibiotics in children with post-operative abscess from perforated appendicitis. Pediatr Surg Int. 2019;35:329–333.
    1. Loux TJ, Falk GA, Burnweit CA, et al. Early transition to oral antibiotics for treatment of perforated appendicitis in pediatric patients: confirmation of the safety and efficacy of a growing national trend. J Pediatric Surg. 2016;51:903–907.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere