European Surgical Societies Rarely Have Recommendations for the Treatment of Appendicitis - a Survey

Overview

Journal Eur J Trauma Emerg Surg

Date 2025 Jan 24

PMID 39856349

Authors

Siri Ronholdt Henriksen

Jacob Rosenberg

Siv Fonnes

Affiliations

Soon will be listed here.

Abstract

Purpose: Guidelines for management and treatment of appendicitis recommends the removal of a normal-looking appendix, but the recommendations are deemed as weak because they are based on low quality evidence. We aimed to provide an overview of the recommendations from the European societies or associations of surgeons regarding the treatment of acute appendicitis and especially recommendations for the macroscopically normal-looking appendix.

Methods: European surgical societies were contacted and sent an electronic questionnaire. Questions concerned if the association had a national guideline or recommended an existing one, and if they recommended a specific approach for the management of the normal-looking appendix, including who decided to remove the appendix.

Results: We contacted surgical societies from 28 European countries, and 17 surgical societies (61%) responded. Two societies had a national guideline for the treatment of appendicitis and one of these addressed how to treat the normal-looking appendix. Most societies (59%) answered that the operating surgeon decided whether to remove the normal-looking appendix. Eleven societies recommended using an existing guideline (65%), four societies (24%) did not recommend a guideline, and two societies did not know.

Conclusion: Only two surgical societies had a published national recommendation or guideline on the treatment of suspected appendicitis, only one had a guideline for the management of the normal-looking appendix, and most societies answered that the operating surgeon decided.

References

Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A . Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020; 15(1):27. PMC: 7386163. DOI: 10.1186/s13017-020-00306-3. View

Di Saverio S, Birindelli A, Kelly M, Catena F, Weber D, Sartelli M . WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg. 2016; 11:34. PMC: 4949879. DOI: 10.1186/s13017-016-0090-5. View

Kumar S, Collings A, Lamm R, Haskins I, Scholz S, Nepal P . SAGES guideline for the diagnosis and treatment of appendicitis. Surg Endosc. 2024; 38(6):2974-2994. DOI: 10.1007/s00464-024-10813-y. View

Sharma A, Duc N, Luu Lam Thang T, Nam N, Ng S, Abbas K . A Consensus-Based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med. 2021; 36(10):3179-3187. PMC: 8481359. DOI: 10.1007/s11606-021-06737-1. View

Edwards P, Roberts I, Clarke M, DiGuiseppi C, Woolf B, Perkins C . Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev. 2023; 11:MR000008. PMC: 10687884. DOI: 10.1002/14651858.MR000008.pub5. View

Logie K, Robinson T, VanHouwelingen L . Management of the normal-appearing appendix during laparoscopy for clinically suspected acute appendicitis in the pediatric population. J Pediatr Surg. 2020; 55(5):893-898. DOI: 10.1016/j.jpedsurg.2020.01.039. View

Sorensen A, Bang-Nielsen A, Levic-Souzani K, Pommergaard H, Jorgensen A, Tolstrup M . Readmission and reoperation rates following negative diagnostic laparoscopy for clinically suspected appendicitis: The "normal" appendix should not be removed - A retrospective cohort study. Int J Surg. 2019; 64:1-4. DOI: 10.1016/j.ijsu.2019.02.001. View

Lee S, Connelly T, Ryan J, Power-Foley M, Neary P . Outcomes of the Macroscopically Normal Appendix Left in Situ in Patients with Suspected Appendicitis. World J Surg. 2022; 46(6):1353-1358. DOI: 10.1007/s00268-022-06497-x. View

Henriksen S, Christophersen C, Rosenberg J, Fonnes S . Varying negative appendectomy rates after laparoscopic appendectomy: a systematic review and meta-analysis. Langenbecks Arch Surg. 2023; 408(1):205. DOI: 10.1007/s00423-023-02935-z. View

10.

Bahta N, Rosenberg J, Fonnes S . Many diagnostic tools for appendicitis: a scoping review. Surg Endosc. 2023; 37(5):3419-3429. DOI: 10.1007/s00464-023-09890-2. View

11.

Sikander B, Rosenberg J, Fonnes S . Individual biomarkers in the blood are not yet applicable in diagnosing complicated appendicitis: A scoping review. Am J Emerg Med. 2023; 67:100-107. DOI: 10.1016/j.ajem.2023.02.016. View

12.

DSouza N, Hicks G, Beable R, Higginson A, Rud B . Magnetic resonance imaging (MRI) for diagnosis of acute appendicitis. Cochrane Database Syst Rev. 2021; 12:CD012028. PMC: 8670723. DOI: 10.1002/14651858.CD012028.pub2. View

13.

Champault G, Rizk N, Ziol M, Taffinder N, Catheline J . [Can we recognize the pathological character of the appendix during laparoscopy? Prospective study: 81 cases]. J Chir (Paris). 1996; 133(7):320-3. View

14.

Grunewald B, Keating J . Should the 'normal' appendix be removed at operation for appendicitis?. J R Coll Surg Edinb. 1993; 38(3):158-60. View

15.

Jaunoo S, Hale A, Masters J, Jaunoo S . An international survey of opinion regarding investigation of possible appendicitis and laparoscopic management of a macroscopically normal appendix. Ann R Coll Surg Engl. 2012; 94(7):476-80. PMC: 3954241. DOI: 10.1308/003588412X13373405385377. View

16.

Jeon B . Predictive factors and outcomes of negative appendectomy. Am J Surg. 2016; 213(4):731-738. DOI: 10.1016/j.amjsurg.2016.05.020. View

17.

Andersson R . Short and long-term mortality after appendectomy in Sweden 1987 to 2006. Influence of appendectomy diagnosis, sex, age, co-morbidity, surgical method, hospital volume, and time period. A national population-based cohort study. World J Surg. 2012; 37(5):974-81. DOI: 10.1007/s00268-012-1856-x. View