Conservative or operative management (open or laparoscopic) of acute appendicitis: the authors reply
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* Gerard J. Fitzmaurice
* Billy McWilliams
* Hisham Hurreiz
* Emanuel Epanomeritakis

We read with interest your response to our article regarding the ongoing debate surrounding the management of acute appendicitis.1 Appendicitis remains the most common cause of the acute abdomen among young adults, and the mainstay of treatment at most centres remains an appendectomy.2 This is despite the fact that other intra-abdominal pathologies, such as diverticulitis, are routinely managed conservatively with antibiotics. Consequently, we undertook a detailed review of all contemporaneous data with respect to the role of antibiotics versus appendectomy in the management of acute appendicitis and found that antibiotics do have a role to play as a bridge to definitive surgery.1 However, the current evidence base does not support the routine use of antibiotics as the mainstay of treatment of acute appendicitis, albeit this evidence was minimal and of poor quality.1 Therefore, we concluded that appendectomy remains the current gold standard for the management of acute appendicitis, a finding that has been echoed in a number of more recent reviews into this topic.1,3,4 Despite this, our overall conclusion remains that definitive evaluation through an appropriately conducted randomized controlled trial should be undertaken to comprehensively examine the optimal management of such a common intra-abdominal pathology.1

You also highlighted a key point that regularly concerns practising surgeons regarding the decision for an open or laparoscopic appendectomy. Laparoscopy is becoming an increasingly used resource in the management of the acute abdomen, particularly in female patients, as it can assist in the diagnosis as well as potential treatment of underlying pathology without the possible deleterious effects of radiation exposure associated with computed tomography. Whereas cost-analysis will always be an issue, we believe that laparoscopy does have benefits over and above traditional open appendectomy in certain cases; however, this was not an area that we specifically examined.

## Footnotes

*   **Competing interests:** None declared.

## References

1.  Fitzmaurice GJ, McWilliams B, Hurreiz H, et al.Antibiotics versus appendectomy in the management of acute appendicitis: a review of the current evidence.Can J Surg 2011;54:307–14.
    
    

2.  1.  Williams NS, 
    2.  Bulstrode CJK, 
    3.  O’Connell PR
    
    O’Connell PR.The vermiform appendixWilliams NS, Bulstrode CJK, O’Connell PRBailey and Love’s Short Practice of Surgery25th edLondon (UK)Hodder Arnold20081204–18.
    
    

3.  Wilms IM, de Hoog DE, de Visser DC, et al.Appendectomy versus antibiotic treatment for acute appendicitis.Cochrane Database Syst Rev 2011;11:CD008359
    
    [PubMed](http://canjsurg.ca/lookup/external-ref?access_num=22071846&link_type=MED&atom=%2Fcjs%2F55%2F3%2FE6.2.atom) 

4.  Liu K, Fogg L.Use of antibiotics alone for treatment of uncomplicated acute appendicitis: a systematic review and meta-analysis.Surgery 2011;150:673–83.
    
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    [Web of Science](http://canjsurg.ca/lookup/external-ref?access_num=000296311400022&link_type=ISI)