RECENT ADVANCEMENTS IN APPENDIX SURGERY

The management of acute appendicitis, despite its global lifetime prevalence of 7–8%, remains mired in therapeutic equipoise, necessitating nuanced, patient-tailored strategies. Non-operative management (NOM)—entailing broadspectrum antibiotics and fluid resuscitation—has emerged as a viable alternative to appendectomy, particularly in lowrisk adults and frail surgical candidates. However, its adoption is tempered by concerns regarding recurrence (~20–30% within 1 year) and occult malignancy risk. Interval appendectomy (IA), performed 8–12 weeks post-diagnosis, is advocated in cases of contained perforation or phlegmon, offering dual benefits: mitigating recurrence and enabling histopathologic exclusion of neoplasms (e.g., mucinous tumors, carcinoids) that may mimic uncomplicated appendicitis.Surgical timing hinges on disease severity and patient physiology. Immediate appendectomy is prioritized for perforated or gangrenous cases, while brief delays (hours) may be permissible in stable, uncomplicated presentations to optimize preoperative parameters. Postoperative protocols remain contentious; prophylactic drain placement, though theorized to reduce abscess formation, risks drain-related morbidity (occlusion, enterocutaneous fistula, ileus).Emerging frontiers include endoscopic appendectomy, an investigational modality leveraging transluminal access for minimally invasive resection, though current evidence remains nascent. Ultimately, therapeutic decisions must integrate clinical acuity, oncologic vigilance, and patient-specific comorbidities, underscoring the imperative for dynamic, evidence-adapted algorithms in this evolving landscape.