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

Open Access 01-12-2020 | Computed Tomography | Review

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Authors: Salomone Di Saverio, Mauro Podda, Belinda De Simone, Marco Ceresoli, Goran Augustin, Alice Gori, Marja Boermeester, Massimo Sartelli, Federico Coccolini, Antonio Tarasconi, Nicola de’ Angelis, Dieter G. Weber, Matti Tolonen, Arianna Birindelli, Walter Biffl, Ernest E. Moore, Michael Kelly, Kjetil Soreide, Jeffry Kashuk, Richard Ten Broek, Carlos Augusto Gomes, Michael Sugrue, Richard Justin Davies, Dimitrios Damaskos, Ari Leppäniemi, Andrew Kirkpatrick, Andrew B. Peitzman, Gustavo P. Fraga, Ronald V. Maier, Raul Coimbra, Massimo Chiarugi, Gabriele Sganga, Adolfo Pisanu, Gian Luigi de’ Angelis, Edward Tan, Harry Van Goor, Francesco Pata, Isidoro Di Carlo, Osvaldo Chiara, Andrey Litvin, Fabio C. Campanile, Boris Sakakushev, Gia Tomadze, Zaza Demetrashvili, Rifat Latifi, Fakri Abu-Zidan, Oreste Romeo, Helmut Segovia-Lohse, Gianluca Baiocchi, David Costa, Sandro Rizoli, Zsolt J. Balogh, Cino Bendinelli, Thomas Scalea, Rao Ivatury, George Velmahos, Roland Andersson, Yoram Kluger, Luca Ansaloni, Fausto Catena

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

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Abstract

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.
Appendix
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Metadata
Title
Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines
Authors
Salomone Di Saverio
Mauro Podda
Belinda De Simone
Marco Ceresoli
Goran Augustin
Alice Gori
Marja Boermeester
Massimo Sartelli
Federico Coccolini
Antonio Tarasconi
Nicola de’ Angelis
Dieter G. Weber
Matti Tolonen
Arianna Birindelli
Walter Biffl
Ernest E. Moore
Michael Kelly
Kjetil Soreide
Jeffry Kashuk
Richard Ten Broek
Carlos Augusto Gomes
Michael Sugrue
Richard Justin Davies
Dimitrios Damaskos
Ari Leppäniemi
Andrew Kirkpatrick
Andrew B. Peitzman
Gustavo P. Fraga
Ronald V. Maier
Raul Coimbra
Massimo Chiarugi
Gabriele Sganga
Adolfo Pisanu
Gian Luigi de’ Angelis
Edward Tan
Harry Van Goor
Francesco Pata
Isidoro Di Carlo
Osvaldo Chiara
Andrey Litvin
Fabio C. Campanile
Boris Sakakushev
Gia Tomadze
Zaza Demetrashvili
Rifat Latifi
Fakri Abu-Zidan
Oreste Romeo
Helmut Segovia-Lohse
Gianluca Baiocchi
David Costa
Sandro Rizoli
Zsolt J. Balogh
Cino Bendinelli
Thomas Scalea
Rao Ivatury
George Velmahos
Roland Andersson
Yoram Kluger
Luca Ansaloni
Fausto Catena
Publication date
01-12-2020
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2020
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-020-00306-3

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