Further Surgical Approaches to Management

The most common surgical approach for uncomplicated appendicitis is a laparoscopic appendicectomy, proven to have reduced rates of post-operative pain and length of hospital stay when compared to older ‘open’ approaches, which are still used for more complicated cases.

A diagnostic laparoscopy may be used in patients whereby the diagnosis remains uncertain (clinically or on imaging), but pain persists and a diagnosis is deemed necessary. They may be performed in conjunction with gynaecology input as there is a high crossover of symptoms in women of child-bearing age.

Isolated appendiceal masses or abscesses without evidence or risk of perforation may be treated conservatively with IV antibiotics at a later date.

There are a number of trials looking at surgical verses non-surgical treatment of appendicitis. Non-surgical treatment consists of antibiotics. This option calls for a clear diagnosis. There is a significant rate of recurrence and some of these patients end up undergoing surgery at a later date.

Learning bite

A Cochrane review has found the laparoscopic approach to have ‘diagnostic’ and ‘therapeutic advantages’.