In the treatment of acute uncomplicated appendicitis, the first-line therapy in all age groups is appendectomy.
In uncomplicated appendicitis, delaying appendectomy by 12 to 24 hours of ongoing antibiotic therapy from the time of diagnosis does not result in an increased rate of perforation.
Patients with the clinical picture of complicated appendicitis should be operated on promptly.
In the presence of an abscess (encapsulated collection of pus).
- Perityphlitic abscess (formation of an encapsulated collection of pus around the appendix/ appendix): If macroabscess → interventional drainage (plastic tube that can be inserted into, for example, a collection of pus (abscess)) in combination with antibiotic therapy and, depending on the course, an interval appendectomy (appendectomy into a symptom-free phase).
- If microabscess → immediate surgery (because usually a puncture is not technically feasible).
1st order
- Appendectomy (surgical removal of the appendix vermiformis):
- 3-Trocar laparoscopy, i.e., minimally invasive via laparoscopy (gold standard; approximately 70% of cases) or
- Laparotomy (abdominal incision)
Other notes
- Children with appendicitis do not necessarily require surgery immediately after hospital admission. One study shows that postponement until a maximum of 24 hours after diagnosis does not increase the risk of complications.
- Recurrent appendicitis in a child should be surgically removed once the inflammation has healed with antibiotic therapy and the child is in stable condition. This is usually done by minimally invasive interval appendicectomy, which is considered particularly safe and very rarely associated with complications.
- See due touncomplicated appendicitis in children and adults also under “Drug therapy”. Note: Risk groups for a conservative therapy procedure are:
- Age > 65 years
- Obesity/obesity (BMI > 30 kg/m2)
- Immunosuppression (suppression of the immune system) or acquired immunodeficiencies (immunodeficiency).
- Evidence of an appendicolith (fecal stone with deposition of calcium or other inorganic salts).
