In 2006 Styrud et al. [43] published the results of a Swedish multicenter randomized trial. In the antibiotic group 86% improved without surgery; a rate of 14% of patients was operated on within 24 hours, and the diagnosis of acute appendicitis was confirmed in all but one

patient, and he was suffering from terminal ileitis; 5% of patients had a perforated appendix in this group. The recurrence rate of symptoms of appendicitis selleck chemicals among the patients treated with antibiotics was 14% during the 1-year follow-up. Recently a further randomized clinical trial by Hanson et al. [44] compared antibiotic therapy versus appendectomy as primary treatment of acute appendicitis. Treatment efficacy was 90.8% for antibiotic therapy and 89.2 per cent for surgery. Recurrent appendicitis occurred in 13.9% of patients treated conservatively after a median of 1 year. Although antibiotics may be used as primary treatment for selected patients with suspected uncomplicated

appendicitis, appendectomy is still the gold standard therapy for acute appendicitis. The advent of minimally Vorinostat solubility dmso invasive surgery has modified the surgical treatment of acute appendicitis and a lot of prospective randomized studies, meta-analyses, and systematic critical reviews have been published on the topic of laparoscopic appendectomy. Laparoscopic appendectomy is safe and effective, but open surgery still conferres benefits, in particular with regards to the likelihood of postoperative intra-abdominal abscess. In 2007 a meta-analysis Selleck Etoposide of 34 studies comparing laparoscopic appendectomy with open appendectomy was published by Bennett et al. [45]. The

meta-analysis confirmed the findings of fewer surgical site infections and shorter hospitalization with laparoscopic appendectomy. Intra-abdominal abscesses were more common with laparoscopic appendectomy. Although appendix abscess occurs in 10% of patients with acute appendicitis, its surgical management is surrounded with controversy. The traditional management of appendiceal mass has been initial conservative treatment followed by interval appendicectomy. Recently interval appendicectomy has been questioned, and there is much controversy whether interval appendicectomy is appropriate for adults with an appendiceal abscess. The main debate is based on the recurrence rate, the complication rate of interval appendicectomy, and the potential for underlying malignancy [46]. The results of a review by Andersonn and Petzold [47], based mainly on retrospective studies, supported the practice of nonsurgical treatment without interval appendectomy in patients with appendiceal abscess or phlegmon. In 2007 another review [48] on management of appendiceal mass demonstrated that conservative management approach was successful in the majority of patients presenting with an appendix mass.