Surgery or antibiotics for acute appendicitis? Take care about study’s design and methodology!

  • Marco Ceresoli
  • Fausto Catena
  • Luca Ansaloni
Letter to the Editor

Dear Editor,

We read with interest the recent article published in your journal by Poillucci et al. about conservative treatment in acute appendicitis. The study is a multicentric retrospective case control study with a propensity score-based matching of the patients with acute appendicitis who received surgery or antibiotic treatment [1]. The study showed that conservative treatment when effective allowed a significant reduction in length of stay and time to return to normal activity. On the other hand, authors found that conservative treatment had an immediate failure rate of 20% and after a mean follow-up of 20 months other 20% of patients had a recurrence of acute appendicitis. Surgical treatment was associated with complications in 13.6% of the patients.

The debate about which is the best treatment in acute appendicitis is very intense and interesting. As well noticed by the authors the debate is not new and despite a discrete number of studies on this topic, we still need...


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.


  1. 1.
    Poillucci G, Mortola L, Podda M et al (2017) Laparoscopic appendectomy vs antibiotic therapy for acute appendicitis: a propensity score-matched analysis from a multicenter cohort study. Updates Surg 69:531–540. CrossRefPubMedGoogle Scholar
  2. 2.
    Di Saverio S, Birindelli A, Kelly MD et al (2016) WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg 11:34. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Laurin M, Lou Everett M, Parker W (2011) The cecal appendix: one more immune component with a function disturbed by post-industrial culture. Anat Rec 294:567–579. CrossRefGoogle Scholar
  4. 4.
    Allievi N, Harbi A, Ceresoli M et al (2017) Acute appendicitis: still a surgical disease? Results from a propensity score-based outcome analysis of conservative versus surgical management from a prospective database. World J Surg. PubMedGoogle Scholar
  5. 5.
    Podda M, Serventi F, Mortola L et al (2017) A prospective non-randomized controlled, multicenter trial comparing Appendectomy and Conservative Treatment for Patients with Uncomplicated Acute Appendicitis (the ACTUAA study). Int J Colorectal Dis 32:1649–1660. CrossRefPubMedGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2018

Authors and Affiliations

  1. 1.General and Emergency SurgeryMilano-Bicocca UniversityMonzaItaly
  2. 2.Emergency SurgeryParma HospitalParmaItaly
  3. 3.General, Emergency and Trauma SurgeryBufalini HospitalCesenaItaly

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