Surgical Approaches to Management

Surgeons must weigh up the risks and benefits of appendicetomy in patients with RIF pain. Negative appendicetomy rates are often in the region of 10-20% and it is important to try and keep this rate low [1,12], while trying to avoid the risks of perforation with its increase in mortality. Negative appendicetomies have been shown to be associated with the female sex, low WCCs, low pulse and age <21 years [17].

A recent study has shown a reduction in the negative appendicectomy rate from 16.3% to 7.65% in a centre in the US where all patients got a CT before theatre [18]. Serial clinical examinations performed by a senior surgeon are still invaluable in deciding whether or not a patient with equivocal findings requires theatre for appendicectomy. This ‘watchful waiting’ approach is often advocated for by senior surgeons in patients with an uncertain diagnosis, though has not been extensively researched.