1. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines
- Author
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Fabio Cesare Campanile, Rifat Latifi, Harry van Goor, Francesco Pata, Michael D. Kelly, Mauro Podda, Zaza Demetrashvili, Massimo Sartelli, R. J. Davies, Dimitrios Damaskos, Zsolt J. Balogh, Antonio Tarasconi, Gustavo Pereira Fraga, Fausto Catena, Fakri Abu-Zidan, Sandro Rizoli, Adolfo Pisanu, Ernest E. Moore, Boris Sakakushev, Richard P. G. ten Broek, Osvaldo Chiara, Matti Tolonen, Gian Luigi De' Angelis, Andrey Litvin, Dieter G. Weber, Kjetil Søreide, Andrew W. Kirkpatrick, Rao R. Ivatury, Raul Coimbra, Cino Bendinelli, Michael Sugrue, Oreste Romeo, Luca Ansaloni, Marja A. Boermeester, Goran Augustin, Gabriele Sganga, Ari Leppäniemi, Marco Ceresoli, Ronald V. Maier, Alice Gori, Walter L. Biffl, George C. Velmahos, Arianna Birindelli, Carlos Augusto Gomes, Massimo Chiarugi, Jeffry L. Kashuk, Nicola De Angelis, David W da Costa, Federico Coccolini, Andrew B. Peitzman, Helmut Segovia-Lohse, Salomone Di Saverio, Yoram Kluger, Belinda De Simone, Thomas M. Scalea, Edward C.T.H. Tan, Isidoro Di Carlo, Roland Andersson, Gian Luca Baiocchi, G. Tomadze, Apollo - University of Cambridge Repository, Di Saverio, S, Podda, M, De Simone, B, Ceresoli, M, Augustin, G, Gori, A, Boermeester, M, Sartelli, M, Coccolini, F, Tarasconi, A, De' Angelis, N, Weber, D, Tolonen, M, Birindelli, A, Biffl, W, Moore, E, Kelly, M, Soreide, K, Kashuk, J, Ten Broek, R, Gomes, C, Sugrue, M, Davies, R, Damaskos, D, Leppaniemi, A, Kirkpatrick, A, Peitzman, A, Fraga, G, Maier, R, Coimbra, R, Chiarugi, M, Sganga, G, Pisanu, A, De' Angelis, G, Tan, E, Van Goor, H, Pata, F, Di Carlo, I, Chiara, O, Litvin, A, Campanile, F, Sakakushev, B, Tomadze, G, Demetrashvili, Z, Latifi, R, Abu-Zidan, F, Romeo, O, Segovia-Lohse, H, Baiocchi, G, Costa, D, Rizoli, S, Balogh, Z, Bendinelli, C, Scalea, T, Ivatury, R, Velmahos, G, Andersson, R, Kluger, Y, Ansaloni, L, Catena, F, HUS Abdominal Center, II kirurgian klinikka, University of Helsinki, and Helsinki University Hospital Area
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UNCOMPLICATED ACUTE APPENDICITIS ,CT scan appendicitis ,Appendicitis / surgery ,Settore MED/18 - CHIRURGIA GENERALE ,Non-operative management ,Delphi method ,Review ,030230 surgery ,Imaging ,SUCCESSFUL NONOPERATIVE TREATMENT ,0302 clinical medicine ,Antibiotics ,Laparoscopy / methods ,Appendicitis guideline ,Grading (education) ,Laparoscopy ,Appendicitis diagnosis score ,Appendiceal absce ,Evidence-Based Medicine ,medicine.diagnostic_test ,Consensus conference ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,C-REACTIVE PROTEIN ,3. Good health ,Anti-Bacterial Agents ,Acute appendicitis ,Appendicitis guidelines ,Jerusalem guidelines ,Alvarado score ,Adult Appendicitis Score ,Complicated appendicitis ,Appendectomy ,Laparoscopic appendectomy ,Diagnostic laparoscopy ,Phlegmon ,Appendiceal abscess ,030220 oncology & carcinogenesis ,Abdominal Pain / surgery ,Acute Disease ,Practice Guidelines as Topic ,MEASURING ANATOMIC SEVERITY ,Emergency Medicine ,CT scan appendiciti ,medicine.medical_specialty ,Jerusalem guideline ,lcsh:Surgery ,[object Object] ,Complicated appendiciti ,ANTIBIOTIC-THERAPY ,COMPLICATED ACUTE APPENDICITIS ,03 medical and health sciences ,medicine ,SURGICAL SITE INFECTION ,Humans ,Abdominal Pain / diagnosis ,Anti-Bacterial Agents / therapeutic use ,3-PORT LAPAROSCOPIC APPENDECTOMY ,business.industry ,General surgery ,Kirurgi ,Antibiotic ,Evidence-based medicine ,lcsh:RD1-811 ,lcsh:RC86-88.9 ,3126 Surgery, anesthesiology, intensive care, radiology ,medicine.disease ,Appendicitis ,INFLAMMATORY RESPONSE SCORE ,Abdominal Pain ,Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] ,Appendicitis / diagnosis ,CLINICAL-PREDICTION RULES ,Surgery ,Acute appendiciti ,business - 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.
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- 2020