Top

Published in:

Open Access 01-12-2020 | Antibiotic | Review

The SIFIPAC/WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition)

Authors: Paola Fugazzola, Marco Ceresoli, Vanni Agnoletti, Ferdinando Agresta, Bruno Amato, Paolo Carcoforo, Fausto Catena, Osvaldo Chiara, Massimo Chiarugi, Lorenzo Cobianchi, Federico Coccolini, Alessandro De Troia, Salomone Di Saverio, Andrea Fabbri, Carlo Feo, Francesco Gabrielli, Angela Gurrado, Angelo Guttadauro, Leonardo Leone, Daniele Marrelli, Luca Petruzzelli, Nazario Portolani, Francesco Paolo Prete, Alessandro Puzziello, Massimo Sartelli, Giorgio Soliani, Mario Testini, Salvatore Tolone, Matteo Tomasoni, Gregorio Tugnoli, Pierluigi Viale, Monica Zese, Offir Ben Ishay, Yoram Kluger, Andrew Kirkpatrick, Luca Ansaloni

Published in: World Journal of Emergency Surgery | Issue 1/2020

Abstract

The epidemiology and the outcomes of acute appendicitis in elderly patients are very different from the younger population. Elderly patients with acute appendicitis showed higher mortality, higher perforation rate, lower diagnostic accuracy, longer delay from symptoms onset and admission, higher postoperative complication rate and higher risk of colonic and appendiceal cancer. The aim of the present work was to investigate age-related factors that could influence a different approach, compared to the 2016 WSES Jerusalem guidelines on general population, in terms of diagnosis and management of elderly patient with acute appendicitis. During the XXIX National Congress of the Italian Society of Surgical Pathophysiology (SIFIPAC) held in Cesena (Italy) in May 2019, in collaboration with the Italian Society of Geriatric Surgery (SICG), the World Society of Emergency Surgery (WSES) and the Italian Society of Emergency Medicine (SIMEU), a panel of experts participated to a Consensus Conference where eight panelists presented a number of statements, which were developed for each of the four topics about diagnosis and management of acute appendicitis in elderly patients, formulated according to the GRADE system. The statements were then voted, eventually modified and finally approved by the participants to the Consensus Conference. The current paper is reporting the definitive guidelines statements on each of the following topics: diagnosis, non-operative management, operative management and antibiotic therapy.

Ceresoli M, Zucchi A, Allievi N, Harbi A, Pisano M, Montori G, Heyer A, Nita GE, Ansaloni L, Coccolini F. Acute appendicitis: epidemiology, treatment and outcomes- analysis of 16544 consecutive cases. World J Gastrointest Surg. 2016 Oct 27;8(10):693–9. https://doi.org/10.4240/wjgs.v8.i10.693.CrossRefPubMedPubMedCentral

Kraemer M, Franke C, Ohmann C, Yang Q and Group, Acute Abdominal Pain Study. Acute appendicitis in late adulthood: incidence, presentation, and outcome. Results of a prospective multicenter acute abdominal pain study and a review of the literature. Langenbecks Arch Surg. 2000 Nov;385(7):470-481. Review.

Kotaluoto S, Ukkonen M, Pauniaho SL, Helminen M, Sand J, Rantanen T. Mortality related to appendectomy; a population based analysis over two decades in Finland. World J Surg. 2017 Jan;41(1):64-69. doi: https://doi.org/10.1007/s00268-016-3688-6. PMID: 27535664.CrossRef

Franz MG, Norman J, Fabri PJ. Increased morbidity of appendicitis with advancing age. Am Surg. 1995 Jan;61(1):40–4.PubMed

Shchatsko A, Brown R, Reid T, Adams S, Alger A, Charles A. The utility of the Alvarado score in the diagnosis of acute appendicitis in the elderly. Am Surg. 2017 Jul 1;83(7):793–8.PubMed

Pokharel N, Sapkota P, Kc B, Rimal S, Thapa S, Shakya R. Acute appendicitis in elderly patients: a challenge for surgeons. Nepal Med Coll J. 2011 Dec;13(4):285–8.PubMed

Lau WY, Fan ST, Yiu TF, Chu KW, Lee JM. Acute appendicitis in the elderly. Surg Gynecol Obstet. 1985 Aug;161(2):157–60.PubMed

Horattas MC, Guyton DP, Wu D. A reappraisal of appendicitis in the elderly. Am J Surg. 1990 Sep;160(3):291–3. https://doi.org/10.1016/S0002-9610(06)80026-7.CrossRefPubMed

Körner H, Söndenaa K, Söreide JA, Andersen E, Nysted A, Lende TH, Kjellevold KH. Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis. World J Surg. 1997 Mar-Apr;21(3):313–7. https://doi.org/10.1007/s002689900235.CrossRefPubMed

10.

Zbierska K, Kenig J, Lasek A, Rubinkiewicz M, Wałęga P. Differences in the clinical course of acute appendicitis in the elderly in comparison to younger population. Pol Przegl Chir. 2016 May 1;88(3):142–6. https://doi.org/10.1515/pjs-2016-0042.CrossRefPubMed

11.

Lunca S, Bouras G, Romedea NS. Acute appendicitis in the elderly patient: diagnostic problems, prognostic factors and outcomes. Rom J Gastroenterol. 2004 Dec;13(4):299–303.PubMed

12.

Segev L, Keidar A, Schrier I, Rayman S, Wasserberg N, Sadot E. Acute appendicitis in the elderly in the twenty-first century. J Gastrointest Surg. 2015 Apr;19(4):730-735. doi: https://doi.org/10.1007/s11605-014-2716-9. Epub 2015 Feb 14.PubMedCrossRef

13.

Sülberg D, Chromik AM, Kersting S, Meurer K, Tannapfel A, Uhl W, Mittelkötter U. Appendicitis in the elderly. CRP value as decision support for diagnostic laparoscopy. Chirurg. 2009 Jul;80(7):608-614. doi: https://doi.org/10.1007/s00104-009-1754-4. German.PubMedCrossRef

14.

Harbrecht BG, Franklin GA, Miller FB, Smith JW, Richardson JD. Acute appendicitis--not just for the young. Am J Surg. 2011 Sep;202(3):286–90. https://doi.org/10.1016/j.amjsurg.2010.08.017.CrossRefPubMed

15.

Marudanayagam R, Williams GT, Rees BI. Review of the pathological results of 2660 appendicectomy specimens. J Gastroenterol. 2006 Aug;41(8):745–9. https://doi.org/10.1007/s00535-006-1855-5.CrossRefPubMed

16.

Pooler BD, Lawrence EM, Pickhardt PJ. MDCT for suspected appendicitis in the elderly: diagnostic performance and patient outcome. Emerg Radiol. 2012 Jan;19(1):27-33. doi: https://doi.org/10.1007/s10140-011-1002-3. Epub 2011 Dec 1.PubMedCrossRef

17.

Barreto SG, Travers E, Thomas T, Mackillop C, Tiong L, Lorimer M, Williams R. Acute perforated appendicitis: an analysis of risk factors to guide surgical decision making. Indian J Med Sci. 2010 Feb;64(2):58–65. https://doi.org/10.4103/0019-5359.94401.CrossRefPubMed

18.

Gürleyik G, Gürleyik E. Age-related clinical features in older patients with acute appendicitis. Eur J Emerg Med. 2003 Sep;10(3):200–3. https://doi.org/10.1097/00063110-200309000-00008.CrossRefPubMed

19.

Agafonoff S, Hawke I, Khadra M, Munnings V, Notaras L, Wadhwa S, Burton R. The influence of age and gender on normal appendicectomy rates. Aust N Z J Surg. 1987 Nov;57(11):843–6.PubMedCrossRef

20.

Cohen-Arazi O, Dabour K, Bala M, Haran A, Almogy G. Management, treatment and outcomes of acute appendicitis in an elderly population: a single-center experience. Eur J Trauma Emerg Surg. 2017 Oct;43(5):723-727. doi: 10.1007/s00068-016-0735-9. Epub 2016 Nov 2, DOI: https://doi.org/10.1007/s00068-016-0735-9.PubMedCrossRef

21.

Bhullar JS, Chaudhary S, Cozacov Y, Lopez P, Mittal VK. Acute appendicitis in the elderly: diagnosis and management still a challenge. Am Surg. 2014 Nov;80(11):E295-E297. No abstract available.

22.

Mc Callion J, Canning GP, Knight PV, Mc Callion JS. Acute appendicitis in the elderly: a 5-year retrospective study. Age Ageing. 1987 Jul;16(4):256–60. https://doi.org/10.1093/ageing/16.4.256.CrossRef

23.

Mc Gowan DR, Howlader MH, Patel R, Swindlehurst N, Manifold D, Shaikh I. Management and outcome of appendicitis among octogenarians in an English hospital over a five year period. Int J Surg. 2011;9(8):669-671. doi: https://doi.org/10.1016/j.ijsu.2011.10.004. Epub 2011 Oct 29.PubMedCrossRef

24.

Hui TT, Major KM, Avital I, Hiatt JR, Margulies DR. Outcome of elderly patients with appendicitis: effect of computed tomography and laparoscopy. Arch Surg. 2002 Sep;137(9):995-998; discussion 999-1000.

25.

Blomqvist PG, Andersson RE, Granath F, Lambe MP, Ekbom AR. Mortality after appendectomy in Sweden, 1987-1996. Ann Surg. 2001 Apr;233(4):455–60. https://doi.org/10.1097/00000658-200104000-00001.CrossRefPubMedPubMedCentral

26.

Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. . BMJ [Internet]. 2008;336:924–926, DOI: https://doi.org/10.1136/bmj.39489.470347.AD.PubMedPubMedCentralCrossRef

27.

Ohle R, et al. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med. 2011;9:139. https://doi.org/10.1186/1741-7015-9-139.CrossRefPubMedPubMedCentral

28.

Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M, Sugrue M, De Moya M, Gomes CA, Bhangu A, Agresta F, Moore EE, Soreide K, Griffiths E, De Castro S, Kashuk J, Kluger Y, Leppaniemi A, Ansaloni L, Andersson M, Coccolini F, et al. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg. 2016 Jul 18;11:34. doi: https://doi.org/10.1186/s13017-016-0090-5. eCollection 2016. Review.

29.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986 May;15(5):557–64. https://doi.org/10.1016/S0196-0644(86)80993-3.CrossRefPubMed

30.

Andersson M, Kolodziej B, Andersson RE and Group., STRAPPSCORE Study. Randomized clinical trial of appendicitis inflammatory response score-based management of patients with suspected appendicitis. Br J Surg. 2017 Oct;104(11):1451-1461. doi: https://doi.org/10.1002/bjs.10637. Epub 2017 Jul 21.PubMedCrossRef

31.

Konan A, Hayran M, Kılıç YA, Karakoç D, Kaynaroğlu V. Scoring systems in the diagnosis of acute appendicitis in the elderly. Ulus Travma Acil Cerrahi Derg. 2011 Sep;17(5):396–400. https://doi.org/10.5505/tjtes.2011.03780.CrossRefPubMed

32.

Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004 Jan;91(1):28–37. https://doi.org/10.1002/bjs.4464.CrossRefPubMed

33.

Yu CW, Juan LI, Wu MH, Shen CJ, Wu JY, Lee CC. Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg. 2013 Feb;100(3):322-329. doi: https://doi.org/10.1002/bjs.9008. Epub 2012 Nov 30.PubMedCrossRef

34.

Cigsar G, Yildirim AC, Anuk T, Guzel H, Gunal E, Gulkan S, Irem B, Bilgin C. Neutrophil to lymphocyte ratio on appendectomy of geriatric and nongeriatric patients. J Invest Surg. 2017 Oct;30(5):285-290. doi: https://doi.org/10.1080/08941939.2016.1241324. Epub 2016 Oct 26.PubMedCrossRef

35.

Gronroos JM. Is there a role for leukocyte and CRP measurements in the diagnosis of acute appendicitis in the elderly? Maturitas. 1999 Mar 15;31(3):255–8. https://doi.org/10.1016/S0378-5122(99)00011-0.CrossRefPubMed

36.

Shin DH, Cho YS, Cho GC, Ahn HC, Park SM, Lim SW, Oh YT, Cho JW, Park SO, Lee YH. Delta neutrophil index as an early predictor of acute appendicitis and acute complicated appendicitis in adults. World J Emerg Surg. 2017 Jul 24;12:32. doi: https://doi.org/10.1186/s13017-017-0140-7. eCollection 2017.

37.

Krajewski S, et al. Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis. Can J Surg. 2011;54(1):43–53. https://doi.org/10.1503/cjs.023509.CrossRefPubMedPubMedCentral

38.

Terasawa T, et al. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med. 2004;141(7):537–46. https://doi.org/10.7326/0003-4819-141-7-200410050-00011.CrossRefPubMed

39.

Andrea S. Doria, Rahim Moineddin, Christian J. Kellenberger, Monica Epelman, Joseph Beyene, Suzanne Schuh, Paul S. Babyn, Paul T. Dick. US or CT for diagnosis of appendicitis in children and adults? A Meta-Analysis. Radiology. 2006 Oct;241(1):83-94. Epub 2006 Aug 23, DOI: https://doi.org/10.1148/radiol.2411050913.PubMedCrossRef

40.

Poortman P, Oostvogel HJ, Bosma E, Lohle PN, Cuesta MA, de Lange-de Klerk ES, Hamming JF. Improving diagnosis of acute appendicitis: results of a diagnostic pathway with standard use of ultrasonography followed by selective use of CT. J Am Coll Surg. 2009 Mar;208(3):434-441. doi: https://doi.org/10.1016/j.jamcollsurg.2008.12.003.PubMedCrossRef

41.

Rub R, Margel D, Soffer D, Kluger Y. Appendicitis in the elderly: what has changed? Isr Med Assoc J. 2000 Mar;2(3):220–3.PubMed

42.

Livingston EH, Woodward WA, Sarosi GA, et al. Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management. Ann Surg. 2007;245:886–92. https://doi.org/10.1097/01.sla.0000256391.05233.aa.CrossRefPubMedPubMedCentral

43.

RE A. The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis. World J Surg. 2007;31:86–92.CrossRef

44.

NJ C. The pathology of acute appendicitis. Ann Diagn Pathol. 2000;4:46–58.CrossRef

45.

Puylaert JB, Rutgers PH, Lalisang RI, De Vries BC, Van der Werf SD, Dörr JP, et al. A prospective study of ultrasonography in the diagnosis of appendicitis. N Engl J Med. 1987;317:666–9. https://doi.org/10.1056/NEJM198709103171103.CrossRefPubMed

46.

Borushok KF, Jeffrey RB Jr, Laing FC, Townsend RR. Sonographic diagnosis of perforation in patients with acute appendicitis. AJR Am J Roentgenol. 1990;154:275–8.PubMedCrossRef

47.

Kim HY, Park JH, Lee YJ, Lee SS, Jeon JJ, Lee KH. Systematic review and meta-analysis of CT features for differentiating complicated and uncomplicated appendicitis. Radiology. 2018;287(1):104–15. https://doi.org/10.1148/radiol.2017171260.CrossRefPubMed

48.

Horrow MM, White DS, Horrow JC. Differentiation of perforated from nonperforated appendicitis at CT. Radiology. 2003 Apr;227(1):46-51. Epub 2003 Feb 28, DOI: https://doi.org/10.1148/radiol.2272020223.PubMedCrossRef

49.

Leeuwenburgh MM, et al. Accuracy of MRI compared with ultrasound imaging and selective use of CT to discriminate simple from perforated appendicitis. Br J Surg. 2014;101(1):e147–55. https://doi.org/10.1002/bjs.9350.CrossRefPubMed

50.

Hlibczuk V, Dattaro JA, Jin Z, Falzon L, Brown MD. Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults: a systematic review. Ann Emerg Med. 2010 Jan;55(1):51-59.e1. doi: https://doi.org/10.1016/j.annemergmed.2009.06.509. Epub 2009 Sep 5.PubMedCrossRef

51.

YC L, et al. American Journal of Roentgenology. 2019;213:728–35.CrossRef

52.

Andersson RE. The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis. World J Surg. 2007;31(1):86–92. https://doi.org/10.1007/s00268-006-0056-y.CrossRefPubMed

53.

Bhangu A, et al. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015;386(10000):1278–87. https://doi.org/10.1016/S0140-6736(15)00275-5.CrossRefPubMed

54.

Varadhan KK, Neal KR, Lobo DN. Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials. BMJ. 2012;344:e2156. https://doi.org/10.1136/bmj.e2156.CrossRefPubMedPubMedCentral

55.

Di Saverio S, et al. The NOTA study (non-operative treatment for acute appendicitis): prospective study on the efficacy and safety of antibiotics (amoxicillin and clavulanic acid) for treating patients with right lower quadrant abdominal pain and long-term follow-up of conser. Ann Surg. 2014;260(1):109–17. https://doi.org/10.1097/SLA.0000000000000560.CrossRefPubMed

56.

Svensson JF, et al. Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial. Ann Surg. 2015;261(1):67–71. https://doi.org/10.1097/SLA.0000000000000835.CrossRefPubMed

57.

Flum DR. Clinical practice. Acute appendicitis–appendectomy or the “antibiotics first” strategy. N Engl J Med. 2015;372(20):1937–43. https://doi.org/10.1056/NEJMcp1215006.CrossRefPubMed

58.

Poon SHT, Lee JWY, Ng KM, Chiu GWY, Wong BYK, Foo CC, Law WL. The current management of acute uncomplicated appendicitis: should there be a change in paradigm? A systematic review of the literatures and analysis of treatment performance. World J Emerg Surg. 2017 Oct 16;12:46. doi: https://doi.org/10.1186/s13017-017-0157-y. eCollection 2017. Review.

59.

Sallinen V, Akl EA, You JJ, Agarwal A, Shoucair S, Vandvik PO, Agoritsas T, Heels-Ansdell D, Guyatt GH, Tikkinen KA. Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis. Br J Surg. 2016 May;103(6):656-667. doi: https://doi.org/10.1002/bjs.10147. Epub 2016 Mar 17. Review.PubMedCrossRef

60.

Horn CB, Tian D, Bochicchio GV, Turnbull IR. Incidence, demographics, and outcomes of nonoperative management of appendicitis in the United States. J Surg Res. 2018 Mar;223:251-258. doi: 10.1016/j.jss.2017.10.007. Epub 2017 Dec 2.PubMedCrossRef

61.

Park HC, Kim MJ, Lee BH. Antibiotic therapy for appendicitis in patients aged ≥80 years. Am J Med. 2014 Jun;127(6):562-564. doi: https://doi.org/10.1016/j.amjmed.2014.01.018. Epub 2014 Feb 3.PubMedCrossRef

62.

Simillis C, et al. A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon). Surgery. 2010;147(6):818–29. https://doi.org/10.1016/j.surg.2009.11.013.CrossRefPubMed

63.

Andersson RE, Petzold MG. Nonsurgical treatment of appendiceal abscess or phlegmon: a systematic review and meta-analysis. Ann Surg. 2007;246(5):741–8. https://doi.org/10.1097/SLA.0b013e31811f3f9f.CrossRefPubMed

64.

Horn CB, Coleoglou Centeno AA, Guerra JJ, Mazuski JE, Bochicchio GV, Turnbull IR. Drain failure in intra-abdominal abscesses associated with appendicitis. Surg Infect (Larchmt). 2018 Apr;19(3):321-325. doi: https://doi.org/10.1089/sur.2017.224. Epub 2018 Feb 12.PubMedCrossRef

65.

Gavriilidis P, Nicola De’Angelis, Katsanos K, Di Saverio S. Acute appendicectomy or conservative treatment for complicated appendicitis (Phlegmon or Abscess)? A systematic review by updated traditional and cumulative meta-analysis. J Clin Med Res. 2019 Jan;11(1):56-64. doi: 10.14740/jocmr3672. Epub 2018 Dec 3.PubMedCrossRef

66.

Bizer LS. Acute appendicitis is rarely the initial presentation of cecal cancer in the elderly patient. J Surg Oncol. 1993 Sep;54(1):45–6. https://doi.org/10.1002/jso.2930540112.CrossRefPubMed

67.

Todd RD, Sarosi GA, Nwariaku F, Anthony T. Incidence and predictors of appendiceal tumors in elderly males presenting with signs and symptoms of acute appendicitis. Am J Surg. 2004 Nov;188(5):500–4. https://doi.org/10.1016/j.amjsurg.2004.07.017.CrossRefPubMed

68.

Mohamed I, Chan S, Bhangu A, Karandikar S. Appendicitis as a manifestation of colon cancer: should we image the colon after appendicectomy in patients over the age of 40 years? Int J Colorectal Dis. 2019 Jan 7. https://doi.org/10.1007/s00384-018-03224-8.PubMedCrossRef

69.

Lai HW, Loong CC, Tai LC, Wu CW, Lui WY. Incidence and odds ratio of appendicitis as first manifestation of colon cancer: a retrospective analysis of 1873 patients. J Gastroenterol Hepatol. 2006 Nov;21(11):1693–6. https://doi.org/10.1111/j.1440-1746.2006.04426.x.CrossRefPubMed

70.

Liu Z, Zhang P, Ma Y, Chen H, Zhou Y, Zhang M, et al. Laparoscopy or not. Surg Laparosc Endosc Percutan Tech [Internet]. 2010 [cited 2019 Jun 1];20:362–370, DOI: https://doi.org/10.1097/SLE.0b013e3182006f40.CrossRef

71.

Kirshtein B, Perry ZH, Mizrahi S, Lantsberg L. Value of laparoscopic appendectomy in the elderly patient. World J Surg. 2009;33:918–22. https://doi.org/10.1007/s00268-008-9916-y.CrossRefPubMed

72.

Ward NT, Ramamoorthy SL, Chang DC, Parsons JK. Laparoscopic appendectomy is safer than open appendectomy in an elderly population. JSLS J Soc Laparoendosc Surg [Internet]. Society of Laparoendoscopic Surgeons; 2014 [cited 2019 Jun 1];18.

73.

Yeh C-C, Wu S-C, Liao C-C, Su L-T, Hsieh C-H, Li T-C. Laparoscopic appendectomy for acute appendicitis is more favorable for patients with comorbidities, the elderly, and those with complicated appendicitis: a nationwide population-based study. Surg Endosc [Internet].Springer-Verlag; 2011 [cited 2019 Feb 11];25:2932–2942, DOI: https://doi.org/10.1007/s00464-011-1645-x.PubMedCrossRef

74.

Southgate E, Vousden N, Karthikesalingam A, Markar SR, Black S, Zaidi A. Laparoscopic vs open appendectomy in older patients. Arch Surg [Internet]. 2012;147:557–562, DOI: https://doi.org/10.1001/archsurg.2012.568.

75.

Mannu GS, Sudul MK, Bettencourt-Silva JH, Cumber E, Li F, Clark AB, et al. Closure methods of the appendix stump for complications during laparoscopic appendectomy. Cochrane Database Syst Rev. 2017;2017, DOI: https://doi.org/10.1002/14651858.CD006437.pub3.

76.

Ceresoli M, Tamini N, Gianotti L, Braga M, Nespoli L. Are endoscopic loop ties safe even in complicated acute appendicitis? A systematic review and meta-analysis. Int J Surg. 2019;68:40–47. https://doi.org/10.1016/j.ijsu.2019.06.011. Epub 2019 Jun 18.PubMedCrossRef

77.

Hilsden R, Khan N, Vogt K, Schlachta CM. Staplers vs. loop-ligature: a cost analysis from the hospital payer perspective. Surg Endosc [Internet]. Springer US; 2019;0:0, DOI: https://doi.org/10.1007/s00464-018-06639-0.PubMedCrossRef

78.

Allemann P, Probst H, Demartines N, Schäfer M. Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis—the role of routine abdominal drainage. Langenbeck’s Arch Surg [Internet]. 2011 [cited 2019 Jun 1];396.

79.

Li Z, Zhao L, Cheng Y, Cheng N, Deng Y. Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. Cochrane Database Syst Rev [Internet]. 2018 [cited 2019 Jun 1];5:CD010168, DOI: https://doi.org/10.1002/14651858.CD010168.pub3.

80.

Teixeira PG, Sivrikoz E, Inaba K, Talving P, Lam L, Demetriades D. Appendectomy timing. Ann Surg [Internet]. 2019 [cited 2019 May 25];256:538–543, DOI: https://doi.org/10.1097/SLA.0b013e318265ea13.PubMedCrossRef

81.

Ingraham AM, Cohen ME, Bilimoria KY, Ko CY, Hall BL, Russell TR, et al. Effect of delay to operation on outcomes in adults with acute appendicitis. Arch Surg [Internet]. 2010 [cited 2019 May 25];145:886, DOI: https://doi.org/10.1001/archsurg.2010.184.PubMedCrossRef

82.

Busch M, Gutzwiller FS, Aellig S, Kuettel R, Metzger U, Zingg U. In-hospital delay increases the risk of perforation in adults with appendicitis. World J Surg [Internet]. 2011 [cited 2019 May 25];35:1626–1633, DOI: https://doi.org/10.1007/s00268-011-1101-z.PubMedCrossRef

83.

United Kingdom National Surgical Research Collaborative A, Bhangu A. Safety of short, in-hospital delays before surgery for acute appendicitis: multicentre cohort study, systematic review, and meta-analysis. Ann Surg [Internet]. 2014 [cited 2019 May 25];259:894-903.

84.

Phillips AW, Jones AE, Sargen K. Should the macroscopically normal appendix be removed during laparoscopy for acute right iliac fossa pain when no other explanatory pathology is found? Surg Laparosc Endosc Percutan Tech. 2009;19(5):392–4. https://doi.org/10.1097/SLE.0b013e3181b71957.CrossRef

85.

Strong S, Blencowe N, Bhangu A, Panagiotopoulou IG, Chatzizacharias N, Rana M, et al. How good are surgeons at identifying appendicitis? Results from a multi-centre cohort study. Int J Surg. Elsevier Ltd. 2015;15:107–12.

86.

Murphy SM, Tierney S, Van Den Broek WT, Bijnen AB. A normal appendix found during diagnostic laparoscopy should not be removed (Br J Surg 2001; 88: 251-254) [4] (multiple letters). Br. J. Surg. 2002. p. 624–5.PubMedCrossRef

87.

Lee M, Paavana T, Mazari F, Wilson TR. The morbidity of negative appendicectomy. Ann R Coll Surg Engl. Royal College of Surgeons of England; 2014;96:517–520, DOI: https://doi.org/10.1308/003588414X13946184903801.PubMedCrossRef

88.

Andersen BR, Kallehave FL, Andersen HK. Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Cochrane Database Syst Rev. 2005;3.

89.

Sartelli M, Chichom-Mefire A, Labricciosa FM, Hardcastle T, Abu-Zidan FM, Adesunkanmi AK, et al. The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2017;12:29.PubMedPubMedCentralCrossRef

90.

Mazuski JE, Tessier JM, May AK, Sawyer RG, Nadler EP, Rosengart MR, et al. The surgical infection society revised guidelines on the management of intra-abdominal infection. Surg Infect (Larchmt) [Internet]. 2017;18:1–76, DOI: https://doi.org/10.1089/sur.2016.261.PubMedCrossRef

91.

Mui LM, Ng CSH, Wong SKH, Lam Y-H, Fung TMK, Fok K-L, et al. Optimum duration of prophylactic antibiotics in acute non-perforated appendicitis. ANZ J Surg [Internet]. 2005 [cited 2019 May 30];75:425–428, DOI: https://doi.org/10.1111/j.1445-2197.2005.03397.x.PubMedCrossRef

92.

Regimbeau JM, Fuks D, Pautrat K, Mauvais F, Haccart V, Msika S, et al. Effect of postoperative antibiotic administration on postoperative infection following cholecystectomy for acute calculous cholecystitis: a randomized clinical trial. JAMA [Internet].2014;312:145, DOI: https://doi.org/10.1001/jama.2014.7586.PubMedCrossRef

93.

Mazeh H, Mizrahi I, Dior U, Simanovsky N, Shapiro M, Freund HR, et al. Role of antibiotic therapy in mild acute calculus cholecystitis: a prospective randomized controlled trial. World J Surg [Internet]. 2012 [cited 2019 May 30];36:1750–1759, DOI: https://doi.org/10.1007/s00268-012-1572-6.PubMedCrossRef

94.

Allo MD, Bennion RS, Kathir K, Thompson JE, Lentz M, Meute M, et al. Ticarcillin/clavulanate versus imipenem/cilistatin for the treatment of infections associated with gangrenous and perforated appendicitis. Am Surg [Internet]. 1999 [cited 2019 May 30];65:99-104.

95.

Hopkins JA, Wilson SE, Bobey DG. Adjunctive antimicrobial therapy for complicated appendicitis: bacterial overkill by combination therapy. World J Surg [Internet]. [cited 2019 May 30];18:933–938.PubMedCrossRef

96.

Taylor E, Dev V, Shah D, Festekjian J, Gaw F. Complicated appendicitis: is there a minimum intravenous antibiotic requirement? A prospective randomized trial. Am Surg [Internet]. 2000 [cited 2019 Jun 1];66:887–890.

97.

Sawyer RG, Claridge JA, Nathens AB, Rotstein OD, Duane TM, Evans HL. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015:372.

98.

Rockwood K, Hogan DB, Mac Knight C. Conceptualisation and measurement of frailty in elderly people. Drugs Aging. 2000 Oct;17(4):295–302. https://doi.org/10.2165/00002512-200017040-00005.CrossRefPubMed

99.

Pisano M, Ceresoli M, Cimbanassi S, Gurusamy K, Coccolini F, Borzellino G, Costa G, Allievi N, Amato B, Boerma D, Calcagno P, Campanati L, Cesare F, et al. 2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population. World Journal of Emergency Surgery. 2019;14:10. https://doi.org/10.1186/s13017-019-0224-7.CrossRefPubMedPubMedCentral

Title: The SIFIPAC/WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition)
Authors: Paola Fugazzola
Marco Ceresoli
Vanni Agnoletti
Ferdinando Agresta
Bruno Amato
Paolo Carcoforo
Fausto Catena
Osvaldo Chiara
Massimo Chiarugi
Lorenzo Cobianchi
Federico Coccolini
Alessandro De Troia
Salomone Di Saverio
Andrea Fabbri
Carlo Feo
Francesco Gabrielli
Angela Gurrado
Angelo Guttadauro
Leonardo Leone
Daniele Marrelli
Luca Petruzzelli
Nazario Portolani
Francesco Paolo Prete
Alessandro Puzziello
Massimo Sartelli
Giorgio Soliani
Mario Testini
Salvatore Tolone
Matteo Tomasoni
Gregorio Tugnoli
Pierluigi Viale
Monica Zese
Offir Ben Ishay
Yoram Kluger
Andrew Kirkpatrick
Luca Ansaloni
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Antibiotic
Appendicitis
Appendicitis
Appendectomy
Published in: World Journal of Emergency Surgery / Issue 1/2020
Electronic ISSN: 1749-7922
DOI: https://doi.org/10.1186/s13017-020-00298-0

At a glance: The STEP trials

Springer Medicine

The SIFIPAC/WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition)

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2020

Trauma system developments reduce mortality in hospitalized trauma patients in Al-Ain City, United Arab Emirates, despite increased severity of injury

Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis revised: Protocol of a systematic review and meta-analysis of results

Trauma induced clotting factor depletion in severely injured children: a single center observational study

Histopathological findings in a COVID-19 patient affected by ischemic gangrenous cholecystitis

Pelvic injury prognosis is more closely related to vascular injury severity than anatomical fracture complexity: the WSES classification for pelvic trauma makes sense

Hey surgeons! It is time to lead and be a champion in preventing and managing surgical infections!