Acute Appendicitis: Surgical Approaches

• DOI: https://doi.org/10.22533/at.ed.15952625140712

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• Abstract:

  Acute appendicitis is the leading cause of acute abdomen and one of the most common surgical emergencies worldwide. Traditionally, appendectomy - initially open and currently preferably laparoscopic - is the gold standard treatment, offering high rates of resolution and rapid recovery, with lower morbidity compared to open surgery. However, accurate diagnosis, especially in differentiating between complicated and uncomplicated cases, remains challenging, even with the use of imaging tests and clinical scores.
  Recently, conservative treatment with antibiotics has been proposed as a viable alternative for uncomplicated appendicitis, especially in selected patients. Trials such as the CODA Trial have shown that this approach can be effective in the short term, with a lower rate of immediate complications, but around 30% of patients treated with antibiotics subsequently require surgery. Surgery remains fundamental for identifying unexpected differential diagnoses, such as neoplasms, and avoiding recurrences and therapeutic failures.
  This review critically discusses surgical strategies - especially laparoscopy - and the growing adoption of antibiotic therapy, highlighting the advantages, risks, limitations and clinical applicability of each.