Editing Appendicitis (section)

== '''Acute uncomplicated appendicitis''' = appendicitis without clinical or radiological evidence of perforation (i.e. phlegmon, inflammatory mass, abscess) ==

* Gold standard - laparoscopic     appendicectomy
** Can be safely delayed 24      hours with no increase in perf rate
** Should happen in first 48      hours of presentation
** Lap vs open - lap has lower      rates of wound infection and faster mobilisation
* Antibiotics - cease at     operation
** However, some      evidence suggests continuing for two doses post-op, which has reduced SSI      in an RCT (Are      Postoperative Intravenous Antibiotics Indicated After Laparoscopic      Appendicectomy for Simple Appendicitis? A Prospective Double-blinded      Randomized Controlled Trial)
** Evidence for 24 hours IV Abx      in gangrenous appendicitis, but probably don't need more (UTD 2024)
* Non-operative management
** There is some evidence for      non-op management with ABx, but unconvincing currently. Questions around      patient selection, recurrent attacks, missed neoplasm.
** Most patients respond      clinically (improved symptoms and bloods)
** 10% require rescue      appendicectomy
*** No way to predict this 10%
** One-year recurrence rate of      25%
** Five-year recurrence rate of      40% (APPAC trial, Finland, 2015), and the presence of appendicolith makes      this more likely
** Consider as safe alternative      if surgery not possible
*** Prohibitive anaesthetic       risk
*** Unable to operate       immediately due to anticoagulation
*** Patient does not want       operation
*** Improving symptoms already
*** Morbidly obese and mild       symptoms
*** Pregnant women in first       trimester with mild appendicitis
*** Radiological appendicitis       without systemic inflammation and minimal local signs