Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
Department of General Surgery, University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Varese, Italy.
World J Emerg Surg. 2020 Apr 15;15(1):27. doi: 10.1186/s13017-020-00306-3.
Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy.
This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients.
The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.
急性阑尾炎（AA）是最常见的急性腹痛病因之一。AA 的诊断仍然具有挑战性，并且在世界范围内不同的医疗环境和实践模式中，其治疗仍存在一些争议。2015 年 7 月，世界急诊外科学会（WSES）在耶路撒冷组织了首次关于成人 AA 诊断和治疗的共识会议，旨在制定基于证据的指南。2019 年 6 月，在奈梅亨举行了一次更新的共识会议，现在已经更新了指南，以提供符合不同临床实践的基于证据的陈述和建议：使用临床评分和影像学诊断 AA、手术的适应证和时机、非手术治疗和抗生素的使用、腹腔镜和手术技术、术中评分以及围手术期抗生素治疗。
本执行纲要总结了 WSES 关于 AA 的诊断和治疗指南。文献检索已更新至 2019 年，根据 GRADE 方法制定了陈述和建议。使用 Delphi 方法对陈述和建议进行投票，参与者和作者委员会对共识会议上的陈述和建议进行投票，如有争议，则对其进行修改，最终投票通过。提供了几个表格，突出了研究主题和问题、搜索语法以及陈述和 WSES 基于证据的推荐。最后，以流程图的形式为成人和儿科（<16 岁）患者提供了两种不同的实用临床算法。
2020 年 WSES 关于 AA 的指南旨在提供以下每个主题的更新基于证据的陈述和建议：（1）诊断，（2）非手术治疗单纯性 AA，（3）阑尾切除术和住院延迟的时机，（4）手术治疗，（5）AA 的术中分级，（6）伴脓肿或脓性包块的穿孔性 AA 的治疗，以及（7）围手术期抗生素治疗。
