Salomone Di Saverio , Arianna Birindelli , Micheal D. Kelly , Fausto Catena , Dieter G. Weber , Massimo Sartelli , Michael Sugrue , Mark De Moya , Carlos Augusto Gomes , Aneel Bhangu , Ferdinando Agresta , Ernest E. Moore , Kjetil Soreide , Ewen Griffiths , Steve De Castro , Jeffry Kashuk , Yoram Kluger , Ari Leppaniemi , Luca Ansaloni , Manne Andersson , Federico Coccolini , Raul Coimbra , Kurinchi S. Gurusamy , Fabio Cesare Campanile , Walter Biffl , Osvaldo Chiara , Fred Moore , Andrew B. Peitzman , Gustavo P. Fraga , David Costa , Ronald V. Maier , Sandro Rizoli , Zsolt J Balogh , Cino Bendinelli , Roberto Cirocchi , Valeria Tonini , Alice Piccinini , Gregorio Tugnoli , Elio Jovine , Roberto Persiani , Antonio Biondi , Thomas Scalea , Philip Stahel , Rao Ivatury , George Velmahos , Roland Andersson
18 July 2016
Acute Appendicitis, Guidelines, Consensus Conference, Alvarado Score, Appendicitis diagnosis score, Non-operative management, Antibiotics, Complicated appendicitis, Appendectomy, Laparoscopic appendectomy, Phlegmon, Appendiceal abscess
Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.