Table 1 Research topics and key questions
From: Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines
Topic | Key questions |
|---|---|
1. Diagnosis | Q.1.1: What is the value of clinical scoring systems in the management of adult patients with suspected appendicitis? Can they be used as a basis for a structured management? Q.1.2: In pediatric patients with suspected acute appendicitis could the diagnosis be based only on clinical scores? Q.1.3: What is the role of serum biomarkers in evaluating adult patients presenting with clinical features evocative of acute appendicitis? Q.1.4: What is the role of serum biomarkers in evaluating pediatric patients presenting clinical features highly suggestive of acute appendicitis? Q.1.5: What is the optimum pathway for imaging in adult patients with suspected acute appendicitis? Q.1.6: What is the optimum pathway for imaging in pediatric patients with suspected acute appendicitis? |
2. Non-operative management of uncomplicated acute appendicitis | Q.2.1: Is non-operative management with or without antibiotics a safe and effective treatment option for adult patients with uncomplicated acute appendicitis? Q.2.2: Is non-operative management with or without antibiotics a safe and effective treatment option for pediatric patients with uncomplicated acute appendicitis? Q.2.3: What is the best non-operative management of patients with uncomplicated acute appendicitis? |
3. Timing of appendectomy and in-hospital delay | Q.3.1: Does in-hospital delay increase the rate of complications or perforation for adult patients with uncomplicated acute appendicitis? Q.3.2: Does in-hospital delay increase the rate of complications or perforation for pediatric patients with uncomplicated acute appendicitis? |
4. Surgical treatment | Q.4.1: Does laparoscopic appendectomy confer superior outcomes compared with open appendectomy for adult patients with acute appendicitis? Q.4.2: Does laparoscopic appendectomy confer superior outcomes compared with open appendectomy for pediatric patients with acute appendicitis? Q.4.3: Does laparoscopic single-incision surgery confer any advantage over the three-trocar technique in performing laparoscopic appendectomy for adult patients with acute appendicitis? Q.4.4: Does laparoscopic single-incision surgery confer any advantage over the three-trocar technique in performing laparoscopic appendectomy for pediatric patients with acute appendicitis? Q.4.5: Is outpatient laparoscopic appendectomy safe and feasible for patients with uncomplicated acute appendicitis? Q.4.6: Is laparoscopic appendectomy indicated over open appendectomy in specific patient groups? Q.4.7: Does aspiration alone confer clinical advantages over lavage and aspiration for patients with complicated acute appendicitis? Q.4.8: Does the type of mesoappendix dissection technique (endoclip, endoloop, electrocoagulation, Harmonic Scalpel, or LigaSure) produce different clinical outcomes for patients with acute appendicitis undergoing appendectomy? Q.4.9: Does the type of stump closure technique (stapler or endoloop, ligation or invagination of the stump) produce different clinical outcomes for patients with acute appendicitis undergoing appendectomy? Q.4.10: Is the use of abdominal drains recommended after appendectomy for complicated acute appendicitis in adult patients? Q.4.11: Is the use of abdominal drains recommended after appendectomy for complicated acute appendicitis in pediatric patients? Q.4.12: What are the best methods to reduce the risk of SSI in open appendectomies with contaminated/dirty wounds? |
5. Intra-operative grading of acute appendicitis | Q.5.1: What is the value of scoring systems for intra-operative grading of acute appendicitis? Q.5.2: Should the macroscopically normal appendix be removed during laparoscopy for acute right iliac fossa pain when no other explanatory pathology is found? |
6. Management of perforated appendicitis with phlegmon or abscess | Q.6.1: Is early appendectomy an appropriate treatment compared with delayed appendectomy for patients with perforated acute appendicitis with phlegmon or abscess? Q.6.2: Is interval appendectomy always indicated for patients with acute appendicitis following successful NOM? |
7. Perioperative antibiotic therapy | Q.7.1: Is preoperative antibiotic therapy recommended for patients with acute appendicitis? Q.7.2: Are postoperative antibiotics always indicated in adult patients following appendectomy? Q.7.3: Are postoperative antibiotics always indicated in pediatric patients following appendectomy? |