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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?