Dahiya Dushyant Singh, Akram Hamzah, Goyal Aman, Khan Abdul Moiz, Shahnoor Syeda, Hassan Khawaja M, Gangwani Manesh Kumar, Ali Hassam, Pinnam Bhanu Siva Mohan, Alsakarneh Saqr, Canakis Andrew, Sheikh Abu Baker, Chandan Saurabh, Sohail Amir Humza
Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, USA.
Department of Internal Medicine, Hamilton Health Sciences, Hamilton, ON L8N 3Z5, Canada.
J Clin Med. 2024 May 22;13(11):3034. doi: 10.3390/jcm13113034.
Globally, acute appendicitis has an estimated lifetime risk of 7-8%. However, there are numerous controversies surrounding the management of acute appendicitis, and the best treatment approach depends on patient characteristics. Non-operative management (NOM), which involves the utilization of antibiotics and aggressive intravenous hydration, and surgical appendectomy are valid treatment options for healthy adults. NOM is also ideal for poor surgical candidates. Another important consideration is the timing of surgery, i.e., the role of interval appendectomy (IA) and the possibility of delaying surgery for a few hours on index admission. IA refers to surgical removal of the appendix 8-12 weeks after the initial diagnosis of appendicitis. It is ideal in patients with a contained appendiceal perforation on initial presentation, wherein an initial nonoperative approach is preferred. Furthermore, IA can help distinguish malignant and non-malignant causes of acute appendicitis, while reducing the risk of recurrence. On the contrary, a decision to delay appendectomy for a few hours on index admission should be made based on the patients' baseline health status and severity of appendicitis. Post-operatively, surgical drain placement may help reduce postoperative complications; however, it carries an increased risk of drain occlusion, fistula formation, and paralytic ileus. Furthermore, one of the most critical aspects of appendectomy is the closure of the appendiceal stump, which can be achieved with the help of endoclips, sutures, staples, and endoloops. In this review, we discuss different aspects of management of acute appendicitis, current controversies in management, and the potential role of endoscopic appendectomy as a future treatment option.
在全球范围内，急性阑尾炎的终生风险估计为7%-8%。然而，围绕急性阑尾炎的治疗存在诸多争议，最佳治疗方法取决于患者的特征。非手术治疗（NOM），即使用抗生素和积极的静脉补液，以及手术阑尾切除术，是健康成年人有效的治疗选择。NOM对于手术条件较差的患者也是理想的选择。另一个重要的考虑因素是手术时机，即间隔阑尾切除术（IA）的作用以及在首次入院时延迟手术数小时的可能性。IA是指在阑尾炎初步诊断后8-12周进行阑尾的手术切除。对于初次就诊时阑尾局限性穿孔的患者是理想的选择，这类患者首选初始非手术治疗方法。此外，IA有助于区分急性阑尾炎的恶性和非恶性病因，同时降低复发风险。相反，在首次入院时决定延迟阑尾切除术数小时应基于患者的基线健康状况和阑尾炎的严重程度。术后，放置手术引流管可能有助于减少术后并发症；然而，它会增加引流管堵塞、瘘管形成和麻痹性肠梗阻的风险。此外，阑尾切除术最关键的方面之一是阑尾残端的闭合，这可以借助内镜夹、缝线、吻合器和内镜圈套器来实现。在本综述中，我们讨论急性阑尾炎治疗的不同方面、当前治疗中的争议以及内镜阑尾切除术作为未来治疗选择的潜在作用。
