Salomone Di Saverio , 1 , 2 , Mauro Podda 3 , Belinda De Simone 4 , Marco Ceresoli 5 , Goran Augustin 6 , Alice Gori 7 , Marja Boermeester 8 , Massimo Sartelli 9 , Federico Coccolini 10 , Antonio Tarasconi 4 , Nicola de’ Angelis 11 , Dieter G. Weber 12 , Matti Tolonen 13 , Arianna Birindelli 14 , Walter Biffl 15 , Ernest E. Moore 16 , Michael Kelly 17 , Kjetil Soreide 18 , Jeffry Kashuk 19 , Richard Ten Broek 20 , Carlos Augusto Gomes 21 , Michael Sugrue 22 , Richard Justin Davies 1 , Dimitrios Damaskos 23 , Ari Leppäniemi 13 , Andrew Kirkpatrick 24 , Andrew B. Peitzman 25 , Gustavo P. Fraga 26 , Ronald V. Maier 27 , Raul Coimbra 28 , Massimo Chiarugi 10 , Gabriele Sganga 29 , Adolfo Pisanu 3 , Gian Luigi de’ Angelis 30 , Edward Tan 20 , Harry Van Goor 20 , Francesco Pata 31 , Isidoro Di Carlo 32 , Osvaldo Chiara 33 , Andrey Litvin 34 , Fabio C. Campanile 35 , Boris Sakakushev 36 , Gia Tomadze 37 , Zaza Demetrashvili 37 , Rifat Latifi 38 , Fakri Abu-Zidan 39 , Oreste Romeo 40 , Helmut Segovia-Lohse 41 , Gianluca Baiocchi 42 , David Costa 43 , Sandro Rizoli 44 , Zsolt J. Balogh 45 , Cino Bendinelli 45 , Thomas Scalea 46 , Rao Ivatury 47 , George Velmahos 48 , Roland Andersson 49 , Yoram Kluger 50 , Luca Ansaloni 51 , Fausto Catena 4
15 April 2020
Acute appendicitis, Appendicitis guidelines, Jerusalem guidelines, Consensus conference, Alvarado score, Appendicitis diagnosis score, Adult Appendicitis Score, Imaging, CT scan appendicitis, Non-operative management, Antibiotics, Complicated appendicitis, Appendectomy, Laparoscopic appendectomy, Diagnostic laparoscopy, Phlegmon, Appendiceal abscess
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.
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.
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.