title: Surgery for appendicitis: is it necessary?
abstract: BACKGROUND
  Appendectomy for acute appendicitis is an effective, universally accepted procedure performed more than 300,000 times annually in the United States. It is generally believed that appendicitis progresses invariably from early inflammation to later gangrene and perforation, and that appendectomy is required for surgical source control. Although non-operative management with antibiotics of uncomplicated diverticulitis, salpingitis, and neonatal enterocolitis is now established, the non-operative management of appendicitis remains largely unexplored.
  
  
  METHODS
  Systematic review of published literature and derived expert opinion.
  
  
  RESULTS
  Clinical, epidemiologic, radiologic, and pathologic evidence is presented for spontaneous resolution of uncomplicated acute appendicitis. The pathogenesis of appendicitis is reviewed with specific consideration of the role of bacterial infection in the pathogenesis. Evidence is also provided documenting the clinical success of non-operative management.
  
  
  CONCLUSIONS
  Appendectomy may not be necessary for the majority of patients with acute uncomplicated appendicitis, as many patients resolve spontaneously and others may be treatable with antibiotics alone. However, the supporting documentation is scant and of poor quality. A randomized, prospective trial of non-operative management versus early appendectomy of acute uncomplicated appendicitis corroborated by radiologic imaging is called for.
authors.affiliation: Division of Emergency Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California and Los Angeles County and USC Medical Center, Los Angeles, California, USA. rmason@surgery.usc.edu
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Mason
mesh_terms: D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy / Q000379:methods* / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D002986:Clinical Trials as Topic; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents