Conservative treatment for acute appendicitis

INTRODUCTION: The exact clinical diagnosis of acute appendicitis is often a challenge, requiring a synthesis of the clinical picture and data from laboratory and imaging studies. At the same time, the presumed pathological phase of the inflammation can significantly determine the treatment strategy and tactics. There are two primary forms of the disease: uncomplicated and complicated. Complicated appendicitis refers to all patients with a gangrenous appendix, with or without perforation, and with evidence of peritonitis, an abscess, or a peri appendicular phlegmon.DISCUSSION: There are significant differences among national, European, and intercontinental consensus guidelines regarding the diagnosis and treatment of acute appendicitis. Appendectomy is the "Gold Standard" of treatment and when there presents advanced laparoscopic expertise the laparoscopic appendectomy is recommended. Conservative treatment with antibiotics is a subject of increasing interest as an alternative to the standard operative surgical approach. Recent studies conclude that most patients with uncomplicated appendicitis can be initially treated conservatively. In complicated forms with a peri appendicular abscess or phlegmon, some authors again advocate for a non-operative initial approach, while others recommend aggressive operative management. A subject of debate in these cases remains the necessity of interval appendectomy after eventual success of the non-operative treatment. There is a lack of definitive consensus on the optimal antibiotic regimen and the duration of treatment. Additional aspects of the conservative treatment are the pre-operative therapyq as well as the post-operative one, particularly in complicated cases.CONCLUSIONS: The main factors in taking the decision for conservative approach are three: In-depth discussion with the patient, adequate patient selection, and dynamic observation of the development of the disease. Conservative treatment with antibiotics is a viable method for selected patients with uncomplicated acute appendicitis. Initial conservative treatment for peri appendicular abscess is the preferred choice of treatment. Appendectomy remains the gold standard in the treatment of acute appendicitis due to its higher long-term effectiveness. Additional studies and evaluation of long-term outcomes in conservative treatment are needed to optimize patient selection criteria and the antibiotics regimen.