title: WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis.
abstract: Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.
authors.affiliation: Emergency and Trauma Surgery - Maggiore Hospital, AUSL, Bologna, Italy.
authors.forename: Salomone
authors.identifier: 0000-0001-5685-5022
authors.initials: S
authors.lastname: Di Saverio
authors.affiliation: S. Orsola Malpighi University Hospital - University of Bologna, Bologna, Italy.
authors.forename: Arianna
authors.initials: A
authors.lastname: Birindelli
authors.affiliation: Locum Surgeon, Acute Surgical Unit, Canberra Hospital, Canberra, ACT Australia.
authors.forename: Micheal D
authors.initials: MD
authors.lastname: Kelly
authors.affiliation: Emergency and Trauma Surgery Department, Maggiore Hospital of Parma, Parma, Italy.
authors.forename: Fausto
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authors.lastname: Catena
authors.affiliation: Trauma and General Surgeon Royal Perth Hospital & The University of Western Australia, Perth, Australia.
authors.forename: Dieter G
authors.initials: DG
authors.lastname: Weber
authors.affiliation: Macerata Hospital, Macerata, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Sartelli
authors.affiliation: Letterkenny Hospital, Donegal, Ireland.
authors.forename: Michael
authors.initials: M
authors.lastname: Sugrue
authors.affiliation: Harvard Medical School - Massachusetts General Hospital, Boston, USA.
authors.forename: Mark
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authors.lastname: De Moya
authors.affiliation: Department of Surgery Hospital Universitario, Universidade General de Juiz de Fora, Juiz de Fora, Brazil.
authors.forename: Carlos Augusto
authors.initials: CA
authors.lastname: Gomes
authors.affiliation: Academic Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Edgabaston, Birmingham, UK.
authors.forename: Aneel
authors.initials: A
authors.lastname: Bhangu
authors.affiliation: General Surgery, Civil Hospital - ULSS19, Veneto, Adria, RO Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Agresta
authors.affiliation: Denver Health System - Denver Health Medical Center, Denver, USA.
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Kjetil
authors.initials: K
authors.lastname: Soreide
authors.affiliation: University Hospitals Birmingham NHS Foundation Trust Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Ewen
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authors.lastname: Griffiths
authors.affiliation: Department of Surgery, OLVG, Amsterdam, The Netherlands.
authors.forename: Steve
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authors.lastname: De Castro
authors.affiliation: Department of Surgery, University of Jerusalem, Jerusalem, Israel.
authors.forename: Jeffry
authors.initials: J
authors.lastname: Kashuk
authors.affiliation: Division of General Surgery, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Kluger
authors.affiliation: Abdominal Center, University of Helsinki, Helsinki, Finland.
authors.forename: Ari
authors.initials: A
authors.lastname: Leppaniemi
authors.affiliation: General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
authors.affiliation: Department of Surgery, Linkoping University, Linkoping, Sweden.
authors.forename: Manne
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authors.lastname: Andersson
authors.affiliation: General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Federico
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authors.affiliation: UCSD Health System - Hillcrest Campus Department of Surgery Chief Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, San Diego, CA USA.
authors.forename: Raul
authors.initials: R
authors.lastname: Coimbra
authors.affiliation: Royal Free Campus, University College London, London, UK.
authors.forename: Kurinchi S
authors.initials: KS
authors.lastname: Gurusamy
authors.affiliation: Department of Surgery, San Giovanni Decollato Andosilla Hospital, Viterbo, Italy.
authors.forename: Fabio Cesare
authors.initials: FC
authors.lastname: Campanile
authors.affiliation: Queen's Medical Center, University of Hawaii, Honolulu, HI USA.
authors.forename: Walter
authors.initials: W
authors.lastname: Biffl
authors.affiliation: Niguarda Hospital, Milan, Italy.
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Chiara
authors.affiliation: University of Florida, Gainesville, USA.
authors.forename: Fred
authors.initials: F
authors.lastname: Moore
authors.affiliation: Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Peitzman
authors.affiliation: Faculdade de Ciências Médicas (FCM) - Unicamp, Campinas, SP Brazil.
authors.forename: Gustavo P
authors.initials: GP
authors.lastname: Fraga
authors.affiliation: Alicante, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Costa
authors.affiliation: Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA USA.
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Maier
authors.affiliation: St. Michael Hospital, Toronto, Canada.
authors.forename: Sandro
authors.initials: S
authors.lastname: Rizoli
authors.affiliation: Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia.
authors.forename: Zsolt J
authors.initials: ZJ
authors.lastname: Balogh
authors.affiliation: Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia.
authors.forename: Cino
authors.initials: C
authors.lastname: Bendinelli
authors.affiliation: Department of Surgery, Terni Hospital, University of Perugia, Terni, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.affiliation: S. Orsola Malpighi University Hospital - University of Bologna, Bologna, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Tonini
authors.affiliation: Trauma Surgery Unit - Maggiore Hospital AUSL, Bologna, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Piccinini
authors.affiliation: Trauma Surgery Unit - Maggiore Hospital AUSL, Bologna, Italy.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Tugnoli
authors.affiliation: Department of Surgery, Maggiore Hospital AUSL, Bologna, Italy.
authors.forename: Elio
authors.initials: E
authors.lastname: Jovine
authors.affiliation: Catholic University, A. Gemelli University Hospital, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Persiani
authors.affiliation: Department of Surgery, University of Catania, Catania, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Biondi
authors.affiliation: R. Adams Cowley Trauma Center, Baltimore, MD USA.
authors.forename: Thomas
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authors.lastname: Scalea
authors.affiliation: Denver Health System - Denver Health Medical Center, Denver, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Stahel
authors.affiliation: Professor Emeritus Virginia Commonwealth University, Richmond, VA USA.
authors.forename: Rao
authors.initials: R
authors.lastname: Ivatury
authors.affiliation: Harvard Medical School - Chief of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, USA.
authors.forename: George
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authors.lastname: Velmahos
authors.affiliation: Department of Surgery, Linkoping University, Linkoping, Sweden.
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keywords: Acute Appendicitis; Alvarado Score; Antibiotics; Appendectomy; Appendiceal abscess; Appendicitis diagnosis score; Complicated appendicitis; Consensus Conference; Guidelines; Laparoscopic appendectomy; Non-operative management; Phlegmon