Keywords
Conservative treatment
Anti-bacterial agents
Appendectomy
Practice guideline
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Abstract
Objective: To analyze current evidence on the conservative management of uncomplicated acute appendicitis, considering efficacy, safety, recurrence, selection criteria, specific populations, and clinical applicability of this strategy. Literature review: Recent evidence indicates a success rate of nonoperative management between 63% and 66% at one year, although with lower overall efficacy than surgical treatment. Appropriate patient selection should consider diagnostic confirmation by imaging, clinical stability, absence of peritonitis or sepsis, presence of an appendicolith, feasibility of follow-up, and shared decision-making, in accordance with the WSES Jerusalem 2025 guidelines. Recurrence remains a relevant limitation, and populations such as the elderly, pregnant women, and children require additional caution due to the limited availability of specific evidence. Economic studies show variable results depending on the healthcare system analyzed. Final considerations: Conservative management constitutes a viable alternative to appendectomy in selected patients, provided that risk of failure, recurrence, individual preferences, and prompt access to surgery in cases of unfavorable evolution are taken into account.
References
AKBAR HF, et al. The efficacy of conservative management in uncomplicated acute appendicitis: a single-center retrospective study. Cureus, 2022; 14(12): e32606.
ASHBROOK M, et al. Outcomes following surgical and nonsurgical treatment for uncomplicated appendicitis in older adults. JAMA Network Open, 2024; 7(8): e2429820.
BARRÍA RODRÍGUEZ AG, et al. Efficacy of non-operative management of uncomplicated acute appendicitis: initial experience in a resource-limited setting. BMJ Paediatrics Open, 2025; 9(1): e003141.
BRUCCHI F, et al. A meta-analysis and trial sequential analysis comparing nonoperative versus operative management for uncomplicated appendicitis: a focus on randomized controlled trials. World Journal of Emergency Surgery, 2024; 19: 2.
BULUT A, et al. Oral antibiotic therapy without hospitalization in uncomplicated acute appendicitis: long-term results from a retrospective cohort study. International Journal of Colorectal Disease, 2025; 40: 234.
DE ALMEIDA LEITE RM, et al. Nonoperative vs operative management of uncomplicated acute appendicitis: a systematic review and meta-analysis. JAMA Surgery, 2022; 157(9): 828-834.
DOLEMAN B, et al. Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database of Systematic Reviews, 2024; 4: CD015038.
FLUM DR, et al. Comparing antibiotics versus surgery for treating appendicitis: the CODA study. Washington: Patient-Centered Outcomes Research Institute, 2023.
GUEVARA-CUELLAR CA, et al. Cost-effectiveness analysis of nonoperative management versus open and laparoscopic surgery for uncomplicated acute appendicitis in Colombia. Cost Effectiveness and Resource Allocation, 2021; 19: 34.
HERROD PJJ, et al. Randomized clinical trials comparing antibiotic therapy with appendicectomy for uncomplicated acute appendicitis: meta-analysis. BJS Open, 2022; 6(4): zrac100.
KARAKAS S, et al. Conservative treatment and follow-up for acute appandicitis. Annals of Medical Research, 2023; 30(1): 143-145.
LUKIĆ I, et al. Comparison of conservative and operative treatment of uncomplicated appendicitis in the pediatric population. Srpski Arhiv za Celokupno Lekarstvo, 2023; 151(3-4): 190-196.
MEIER J, et al. Outcomes of nonoperative vs operative management of acute appendicitis in older adults in the US. JAMA Surgery, 2023; 158(6): 625-632.
PODDA M, et al. Diagnosis and treatment of acute appendicitis: 2025 edition of the World Society of Emergency Surgery Jerusalem Guidelines. JAMA Surgery, 2026; 161(3): 283-295.
POPROM N, et al. Cost utility analysis of antibiotics compared with operative treatment in uncomplicated acute appendicitis. Scientific Reports, 2025; 15: 14963.
SALMINEN P, et al. Antibiotics versus placebo in adults with CT-confirmed uncomplicated acute appendicitis (APPAC III): randomized double-blind superiority trial. British Journal of Surgery, 2022; 109(6): 503-509.
SALMINEN P, et al. Appendicitis. Nature Reviews Disease Primers, 2025; 11(1): 79.
SCHEIJMANS JCG, et al. Antibiotic treatment versus appendicectomy for acute appendicitis in adults: an individual patient data meta-analysis. The Lancet Gastroenterology and Hepatology, 2025; 10(3): 222-233.
SEVİNÇ B, et al. Nonoperative management of uncomplicated acute appendicitis: results of 5 years follow. Langenbeck’s Archives of Surgery, 2025; 410: 292.
WELEDJI EP, et al. Management of appendicitis: appendicectomy, antibiotic therapy, or both? Annals of Medicine and Surgery, 2023; 85(4): 897-901.
WEST H, GARCEA G. One-year follow-up of conservative management of appendicitis: results from a single centre during extended lockdown in the COVID-19 pandemic. Annals of the Royal College of Surgeons of England, 2023; 105(S2): S54-S59.
ZHANG Y, et al. Is nonoperative management of appendicitis viable and effective in elderly patients? A study based on a real-world scenario. Asian Journal of Surgery, 2025; 48: 5294-5296.
ZULFIKAROGLU B. Reappraising appendicitis: a systematic review and meta-analysis of evolving treatment paradigms. European Surgery, 2025.