Acute appendicitis - history and current management standards.

Background

Acute appendicitis is still the most common cause of acute abdomen requiring emergency surgical intervention. This review aims to summarize the historical evolution of therapeutic strategies and present current standard management methods for acute appendicitis based on the latest international evidence-based guidelines.

Methods

This review is based on a comprehensive analysis of recent scientific literature, meta-analyses, and current clinical practice guidelines, including the World Society of Emergency Surgery (WSES) 2025 guidelines and American College of Surgeons (ACS) manuals.

Results

Historically, treatment evolved from conservative treatment to open appendectomy via McBurney's incision and today's gold standard of laparoscopic appendectomy. Technical aspects of laparoscopy were thoroughly analyzed - including optimal port selection, mesoappendix division, appendiceal stump closure methods, and the use of specimen retrieval bags to prevent surgical site and intra-abdominal infections. The role of primary antibiotic therapy for uncomplicated appendicitis is also evaluated. While serving as a valid non-operative alternative in selected patients, it carries a substantial long-term recurrence rate. In complicated appendicitis (perforation, phlegmon, or abscess) an individualized step-up strategy is recommended, including both conservative treatment with intravenous antibiotics and percutaneous drainage, as well as surgical options ranging from appendectomy to cecal base or even ileocecal resection. Diagnostic and therapeutic difficulties during pregnancy are also outlined.

Conclusion

Despite all technological advancements, well-timed clinical diagnosis and the surgeon's ability to set the therapeutic strategy based on specific patient conditions and disease severity remain key determinants of optimal clinical outcomes.