Practical issues in treatment of appendicitis

Appendicitis is a common cause of acute abdominal pain and an appendectomy is still the gold standard of treatment. In spite of the high incidence, variance in diagnostic and treatment modalities remains an issue among surgeons. In this thesis several practical issues in the diagnosis and treatment of appendicitis are investigated and discussed.
For a significant part of this thesis, a prospective multicentre ‘snapshot’ study was conducted to evaluate various aspects and outcomes of surgical treatment for acute appendicitis. A ‘snapshot’ study comprises short-term multicentre research that is conceived and implemented by (surgical) trainees. The ‘snapshot’ appendicitis study was the first Dutch study conducted according to a novel study design. In this study, 1975 consecutive patients were included by 62 Dutch hospitals in a 2-month time frame.
The currently standard preoperative imaging in the Netherlands has successfully reduced the normal appendectomy rate to a very low number, especially compared to other countries or historical cohorts.
Laparoscopy is nowadays the prevailing technique for an appendectomy and proved to lower the surgical site infection rate compared to open surgery.
After surgery for acute complicated appendicitis the standard prolongation of antibiotic treatment can be limited to 3 days and possibly even shorter.
For closure of the appendix stump in laparoscopy, routine endoloop use is advised over endostapler use for cost considerations because similar outcomes in terms of complications were found after using these closure techniques.