CONTEMPORARY APPROACHES IN THE MANAGEMENT OF ACUTE APPENDICITIS: A CRITICAL COMPARISON BETWEEN SURGICAL TREATMENT AND CONSERVATIVE ANTIBIOTIC THERAPY

HAXHIREXHA, Kastriot and Zeqiri, Gazmend and BESIMI, Ilber and Selimi, Florim and DEMIRI, Arben and Alili, Roland and MUSLI, Nazim and IMERI, Natmir and AMITI, Rian and JAKUPI, Jakup (2026) CONTEMPORARY APPROACHES IN THE MANAGEMENT OF ACUTE APPENDICITIS: A CRITICAL COMPARISON BETWEEN SURGICAL TREATMENT AND CONSERVATIVE ANTIBIOTIC THERAPY. In: INTERNATIONAL CONFERENCE “FROM RESEARCH TO APPLICATION”, 20 May, 2026.

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Abstract

Background: Acute appendicitis is among the most common abdominal surgical emergencies worldwide (Ferris et al., 2017; Yang et al., 2023). Although appendectomy has historically been considered the definitive treatment, evidence from large randomized trials and long-term follow-up over the past decade has reframed antibiotic therapy as a viable first-line alternative (Salminen et al., 2015; Flum et al., 2020). Objective: This paper aims to critically analyze the most recent scientific evidence regarding the effectiveness, safety, and long-term durability of the two therapeutic strategies, with particular attention to the patient profiles that benefit from each approach. Materials and methods: A structured narrative review of contemporary literature (2015–2026) was conducted, including the randomized APPAC (Salminen et al., 2015), APPAC II (Sippola et al., 2021), and CODA (Flum et al., 2020) trials, along with their long-term follow-ups, recent meta-analyses (Herrod et al., 2022; Brucchi et al., 2024), and international guidelines from the WSES (Di Saverio et al., 2020) and SAGES (Kumar et al., 2024). Results: The 10-year APPAC follow-up shows that approximately 56% of patients initially treated with antibiotics ultimately avoided appendectomy, with a recurrence rate of 37.8% and a markedly lower cumulative complication rate (8.5% versus 27.4%; Salminen et al., 2026). The CODA trial confirmed non-inferiority for quality-of-life outcomes but identified appendicolith as a predictor of early treatment failure (Davidson et al., 2021). Recent meta-analyses report 1-year antibiotic success rates of 62.9–64.6% (Herrod et al., 2022; Brucchi et al., 2024). Conclusion: Conservative antibiotic therapy is a safe and effective alternative for carefully selected patients with CT-confirmed uncomplicated acute appendicitis, whereas laparoscopic appendectomy remains the standard treatment for complicated appendicitis and for patients with high-risk appendicolith. Modern decision-making should be individualized.

Item Type:	Conference or Workshop Item (Paper)
Subjects:	R Medicine > R Medicine (General)
Divisions:	Faculty of Medicine, Health and Life Sciences > School of Medicine
Depositing User:	Unnamed user with email zshi@unite.edu.mk
Date Deposited:	22 Sep 2026 12:58
Last Modified:	22 Sep 2026 12:58
URI:	http://eprints.unite.edu.mk/id/eprint/2453

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