Fast Five Quiz: Appendicitis Diagnosis and Treatment

Richard H. Sinert, DO


March 13, 2019

Fair and colleagues used data from the American College of Surgeons National Surgical Quality Improvement Project to evaluate 30-day morbidity and mortality of intervention (laparoscopic and open appendectomy) at different periods (adjusted for preoperative risk factors) and found similar outcomes when appendectomy was performed within 24 hours and when it was performed between 24 and 48 hours. However, a delay of operative intervention longer than 48 hours was associated with doubling of complication rates. In a separate study, Boomer and colleagues reported that delaying appendectomy (16 hours from presentation in the emergency department or 12 hours from inpatient admission) in children did not result in higher rates of surgical-site infections.

Preoperative antibiotics have demonstrated efficacy in decreasing postoperative wound infection rates in numerous prospective controlled studies, and they should be administered in conjunction with the surgical consultant. Broad-spectrum gram-negative and anaerobic coverage is indicated. Penicillin-allergic patients should avoid beta-lactamase type antibiotics and cephalosporins. Carbapenems are a good option in these patients. Pregnant patients should receive pregnancy category A or B antibiotics.

According to the 2010 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guideline, the indications for laparoscopic appendectomy are identical to those for open appendectomy. The 2010 SAGES guideline lists the following conditions as suitable for laparoscopic appendectomy:

  • Uncomplicated appendicitis

  • Appendicitis in pediatric patients

  • Suspected appendicitis in pregnant women

According to the SAGES guideline, laparoscopic appendectomy may be the preferred approach in the following cases:

  • Perforated appendicitis

  • Appendicitis in elderly patients

  • Appendicitis in obese patients

Read more on the surgical treatment of appendicitis.

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