Slovenská chirurgia 2/2014

Management of acute appendicitis in the adult population – what is the evidence?

Aims.To assess current management of acute appendicitis in the adult population based on the best available evidence. Material and methods.Potentially relevant studies were identified searching Medline database (using mesh terms „appendicitis“ AND „appendectomy“ OR „appendicectomy“ AND „laparoscopic“ OR „open“). Analysis of content was performed in order to synthetize the best available evidence. Results.Overall 34 literature sources were analyzed including randomized controlled trials, meta-analyses, prospective and retrospective clinical cohort studies, review articles and recommendations and guidelines of professional societies. Conclusions.Optimal treatment strategy in the adult patients with acute appendicitis is surgical – laparoscopic appendectomy with toilette of the abdominal cavity ± drainage. The main arguments in favor of laparoscopic approach include diagnostic potential of laparoscopy, minimal surgical trauma and significant reduction of early and late wound complications. Such an approach is the most beneficial in females in the reproductive age, obese and economically active patients. SILS and NOTES techniques should be limited to safety and feasibility clinical studies.

Keywords: acute appendicitis, laparoscopy, laparoscopic surgery, evidence based medicine.