TY - JOUR
T1 - Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines
AU - Di Saverio, Salomone
AU - Podda, Mauro
AU - De Simone, Belinda
AU - Ceresoli, Marco
AU - Augustin, Goran
AU - Gori, Alice
AU - Boermeester, Marja
AU - Sartelli, Massimo
AU - Coccolini, Federico
AU - Tarasconi, Antonio
AU - De' Angelis, Nicola
AU - Weber, Dieter G.
AU - Tolonen, Matti
AU - Birindelli, Arianna
AU - Biffl, Walter
AU - Moore, Ernest E.
AU - Kelly, Michael
AU - Soreide, Kjetil
AU - Kashuk, Jeffry
AU - Ten Broek, Richard
AU - Gomes, Carlos Augusto
AU - Sugrue, Michael
AU - Davies, Richard Justin
AU - Damaskos, Dimitrios
AU - Leppäniemi, Ari
AU - Kirkpatrick, Andrew
AU - Peitzman, Andrew B.
AU - Fraga, Gustavo P.
AU - Maier, Ronald V.
AU - Coimbra, Raul
AU - Chiarugi, Massimo
AU - Sganga, Gabriele
AU - Pisanu, Adolfo
AU - De' Angelis, Gian Luigi
AU - Tan, Edward
AU - Van Goor, Harry
AU - Pata, Francesco
AU - Di Carlo, Isidoro
AU - Chiara, Osvaldo
AU - Litvin, Andrey
AU - Campanile, Fabio C.
AU - Sakakushev, Boris
AU - Tomadze, Gia
AU - Demetrashvili, Zaza
AU - Latifi, Rifat
AU - Abu-Zidan, Fakri
AU - Romeo, Oreste
AU - Segovia-Lohse, Helmut
AU - Baiocchi, Gianluca
AU - Costa, David
AU - Rizoli, Sandro
AU - Balogh, Zsolt J.
AU - Bendinelli, Cino
AU - Scalea, Thomas
AU - Ivatury, Rao
AU - Velmahos, George
AU - Andersson, Roland
AU - Kluger, Yoram
AU - Ansaloni, Luca
AU - Catena, Fausto
PY - 2020
Y1 - 2020
N2 - 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.
AB - 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.
KW - Acute appendicitis
KW - Adult Appendicitis Score
KW - Alvarado score
KW - Antibiotics
KW - Appendectomy
KW - Appendiceal abscess
KW - Appendicitis diagnosis score
KW - Appendicitis guidelines
KW - CT scan appendicitis
KW - Complicated appendicitis
KW - Consensus conference
KW - Diagnostic laparoscopy
KW - Imaging
KW - Jerusalem guidelines
KW - Laparoscopic appendectomy
KW - Non-operative management
KW - Phlegmon
KW - Acute appendicitis
KW - Adult Appendicitis Score
KW - Alvarado score
KW - Antibiotics
KW - Appendectomy
KW - Appendiceal abscess
KW - Appendicitis diagnosis score
KW - Appendicitis guidelines
KW - CT scan appendicitis
KW - Complicated appendicitis
KW - Consensus conference
KW - Diagnostic laparoscopy
KW - Imaging
KW - Jerusalem guidelines
KW - Laparoscopic appendectomy
KW - Non-operative management
KW - Phlegmon
UR - http://hdl.handle.net/10807/159056
U2 - 10.1186/s13017-020-00306-3
DO - 10.1186/s13017-020-00306-3
M3 - Article
SN - 1749-7922
VL - 15
SP - 27-N/A
JO - World Journal of Emergency Surgery
JF - World Journal of Emergency Surgery
ER -