Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines
Creators: name: Di Saverio, Salomone
name: Podda, Mauro
name: De Simone, Belinda
name: Ceresoli, Marco
name: Augustin, Goran
name: Gori, Alice
name: Boermeester, Marja
name: Sartelli, Massimo
name: Coccolini, Federico
name: Tarasconi, Antonio
name: De’ Angelis, Nicola
name: Weber, Dieter G.
name: Tolonen, Matti
name: Birindelli, Arianna
name: Biffl, Walter
name: Moore, Ernest E.
name: Kelly, Michael
name: Soreide, Kjetil
name: Kashuk, Jeffry
name: Ten Broek, Richard
name: Gomes, Carlos Augusto
name: Sugrue, Michael
name: Davies, Richard Justin
name: Damaskos, Dimitrios
name: Leppäniemi, Ari
name: Kirkpatrick, Andrew
name: Peitzman, Andrew B.
name: Fraga, Gustavo P.
name: Maier, Ronald V.
name: Coimbra, Raul
name: Chiarugi, Massimo
name: Sganga, Gabriele
name: Pisanu, Adolfo
name: De’ Angelis, Gian Luigi
name: Tan, Edward
name: Van Goor, Harry
name: Pata, Francesco
name: Di Carlo, Isidoro
name: Chiara, Osvaldo
name: Litvin, Andrey
name: Campanile, Fabio C.
name: Sakakushev, Boris
name: Tomadze, Gia
name: Demetrashvili, Zaza
name: Latifi, Rifat
name: Abu-Zidan, Fakri
name: Romeo, Oreste
name: Segovia-Lohse, Helmut
name: Baiocchi, Gianluca
name: Costa, David
name: Rizoli, Sandro
name: Balogh, Zsolt J.
name: Bendinelli, Cino
name: Scalea, Thomas
name: Ivatury, Rao
name: Velmahos, George
name: Andersson, Roland
name: Kluger, Yoram
name: Ansaloni, Luca
name: Catena, Fausto
Publisher: name: Apollo - University of Cambridge Repository
Year: 2020
Subjects: Review
Acute appendicitis
Appendicitis guidelines
Jerusalem guidelines
Consensus conference
Alvarado score
Appendicitis diagnosis score
Adult Appendicitis Score
Imaging
CT scan appendicitis
Non-operative management
Antibiotics
Complicated appendicitis
Appendectomy
Laparoscopic appendectomy
Diagnostic laparoscopy
Phlegmon
Appendiceal abscess

description: 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 (&lt; 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.