World Journal of Emergency Surgery (Apr 2020)
Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines
- 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
Affiliations
- Salomone Di Saverio
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital
- Mauro Podda
- Department of General and Emergency Surgery, Cagliari University Hospital
- Belinda De Simone
- Emergency and Trauma Surgery Department, Maggiore Hospital of Parma
- Marco Ceresoli
- Emergency and General Surgery Department, University of Milan-Bicocca
- Goran Augustin
- Department of Surgery, University Hospital Centre of Zagreb
- Alice Gori
- Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District
- Marja Boermeester
- Department of Surgery, University of Amsterdam
- Massimo Sartelli
- Macerata Hospital
- Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital
- Antonio Tarasconi
- Emergency and Trauma Surgery Department, Maggiore Hospital of Parma
- Nicola de’ Angelis
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital
- Dieter G. Weber
- Trauma and General Surgeon Royal Perth Hospital & The University of Western Australia
- Matti Tolonen
- Department of Abdominal Surgery, Abdominal Center, University of Helsinki and Helsinki University Central Hospital
- Arianna Birindelli
- Department of General Surgery, Azienda Socio Sanitaria Territoriale
- Walter Biffl
- Queen’s Medical Center, University of Hawaii
- Ernest E. Moore
- Denver Health System – Denver Health Medical Center
- Michael Kelly
- Acute Surgical Unit, Canberra Hospital
- Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital
- Jeffry Kashuk
- Department of Surgery, University of Jerusalem
- Richard Ten Broek
- Department of Surgery, Radboud University Medical Center
- Carlos Augusto Gomes
- Department of Surgery Hospital Universitario, Universidade General de Juiz de Fora
- Michael Sugrue
- Letterkenny Hospital
- Richard Justin Davies
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital
- Dimitrios Damaskos
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh
- Ari Leppäniemi
- Department of Abdominal Surgery, Abdominal Center, University of Helsinki and Helsinki University Central Hospital
- Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre
- Andrew B. Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian
- Gustavo P. Fraga
- Faculdade de Ciências Médicas (FCM) – Unicamp
- Ronald V. Maier
- Department of Surgery, University of Washington, Harborview Medical Center
- Raul Coimbra
- UCSD Health System - Hillcrest Campus Department of Surgery Chief Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery
- Massimo Chiarugi
- General, Emergency and Trauma Surgery, Pisa University Hospital
- Gabriele Sganga
- Department of Emergency Surgery, “A. Gemelli Hospital”, Catholic University of Rome
- Adolfo Pisanu
- Department of General and Emergency Surgery, Cagliari University Hospital
- Gian Luigi de’ Angelis
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma
- Edward Tan
- Department of Surgery, Radboud University Medical Center
- Harry Van Goor
- Department of Surgery, Radboud University Medical Center
- Francesco Pata
- Department of Surgery, Nicola Giannettasio Hospital, Corigliano-Rossano, and La Sapienza University of Rome
- Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies “GF Ingrassia”, Cannizzaro Hospital, University of Catania
- Osvaldo Chiara
- Niguarda Hospital Trauma Center
- Andrey Litvin
- Department of Surgery, Immanuel Kant Baltic Federal University
- Fabio C. Campanile
- Department of Surgery, San Giovanni Decollato Andosilla Hospital
- Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George
- Gia Tomadze
- Department of Surgery, Tbilisi State Medical University, TSMU
- Zaza Demetrashvili
- Department of Surgery, Tbilisi State Medical University, TSMU
- Rifat Latifi
- Section of Acute Care Surgery, Westchester Medical Center, Department of Surgery, New York Medical College
- Fakri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University
- Oreste Romeo
- Bronson Trauma Surgery
- Helmut Segovia-Lohse
- Hospital de Clinicas, Universidad Nacional de Asuncion
- Gianluca Baiocchi
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia
- David Costa
- Hospital universitario de Alicante, departamento de Cirugia General
- Sandro Rizoli
- Department of Surgery, St. Michael Hospital, University of Toronto
- Zsolt J. Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle
- Cino Bendinelli
- Department of Traumatology, John Hunter Hospital and University of Newcastle
- Thomas Scalea
- R. Adams Cowley Trauma Center
- Rao Ivatury
- Professor Emeritus Virginia Commonwealth University
- George Velmahos
- Harvard Medical School, Massachusetts General Hospital
- Roland Andersson
- Department of Surgery, Linkoping University
- Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus
- Luca Ansaloni
- Department of General Surgery and Trauma, Bufalini Hospital
- Fausto Catena
- Emergency and Trauma Surgery Department, Maggiore Hospital of Parma
- DOI
- https://doi.org/10.1186/s13017-020-00306-3
- Journal volume & issue
-
Vol. 15,
no. 1
pp. 1 – 42
Abstract
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.
Keywords
- Acute appendicitis
- Appendicitis guidelines
- Jerusalem guidelines
- Consensus conference
- Alvarado score
- Appendicitis diagnosis score
