AB135. International survey on current management issues of acute appendicitis
Session 10: General III

AB135. International survey on current management issues of acute appendicitis

Patrick Anthony Boland1, Noel Edward Donlon1,2, Michael Eamon Kelly1,2, Andrew Sheppard2, Maria Davern2, Waqar Khan1, Iqbal Khan1, Ronan Waldron1, Kevin Barry1,3

1Department of General Surgery, Mayo University Hospital, Mayo, Ireland; 2Department of General Surgery, St. James’ Hospital, Dublin, Ireland; 3Discipline of Surgery, National University of Ireland, Galway, Ireland


Background: In recent decades the management of acute appendicitis has evolved significantly. Improved imaging modalities along with clinical scoring algorithms have prompted a demand for lower rates of negative appendicectomy. In particular, non-operative management has become in-vogue within the past number of years. The aim of this study was to assess the variability of management options amongst consultants and trainees.

Methods: Multi-national targeted survey of general surgeons across 38 countries. A structured set of questions was utilised to delineate nuances between management styles of consultants and trainees alike. Opinions on the pathological diagnosis of appendicitis, acceptable negative appendicectomy rates and non-operative treatment of appendicitis (NOTA) were surveyed.

Results: A total of 304 general surgeons responded to this survey, 42% of which were consultants/attendings. Sixty-nine percent advocated that a histologically normal appendix was the most appropriate definition of a negative appendicectomy while 29% felt anything other than inflammation, necrosis, gangrene or perforation was most appropriate. 34% felt that negative appendicetomy rates should be less than 5%. Forty-one percent reported that their own negative appendicectomy rate was <5%. Only 17% reported routinely using NOTA for uncomplicated appendicitis. However, only 22% said they would agree to NOTA if they themselves had uncomplicated appendicitis.

Conclusions: This study represents the largest sampling of management strategies for acute appendicitis. It shows substantial heterogeneity between clinicians regarding what constitutes a negative appendicectomy as well as the appropriateness of non-operative management.

Keywords: Appendicitis; general surgery; pathology


doi: 10.21037/map.2020.AB135
Cite this abstract as: Boland PA, Donlon NE, Kelly ME, Sheppard A, Davern M, Khan W, Khan I, Waldron R, Barry K. International survey on current management issues of acute appendicitis. Mesentery Peritoneum 2020;4:AB135.