Background Appendicitis is an extremely common disease with a variety of medical and surgical treatment approaches. A  multidisciplinary expert panel was convened to develop evidence-based recommendations to support clinicians and patients  in decisions regarding the diagnosis and treatment of appendicitis. 

Methods A systematic review was conducted from 2010 to 2022 to answer 8 key questions relating to the diagnosis of  appendicitis, operative or nonoperative management, and specifc technical and post-operative issues for appendectomy.  The results of this systematic review were then presented to a panel of adult and pediatric surgeons. Evidence-based recommendations were formulated using the GRADE methodology by subject experts. 

Results Conditional recommendations were made in favor of uncomplicated and complicated appendicitis being managed  operatively, either delayed (>12h) or immediate operation (<12h), either suction and lavage or suction alone, no routine drain  placement, treatment with short-term antibiotics postoperatively for complicated appendicitis, and complicated appendicitis  previously treated nonoperatively undergoing interval appendectomy. A conditional recommendation signals that the benefts  of adhering to a recommendation probably outweigh the harms although it does also indicate uncertainty. 

Conclusions These recommendations should provide guidance with regard to current controversies in appendicitis. The  panel also highlighted future research opportunities where the evidence base can be strengthened.

背景：阑尾炎是一种极为常见的疾病，有多种内外科治疗途径。召集多学科专家小组制定循证建议，支持临床医生和患者关于阑尾炎诊断和治疗的决策。

方法：从2010年到2022年进行了一项系统性综述，以回答与阑尾炎的诊断、手术或非手术治疗相关的8个关键问题，并具体说明阑尾切除术的技术和术后问题。然后将本系统综述的结果呈现给成人和小儿外科医生小组。由主题专家使用GRADE方法制定基于证据的建议。
结果：有条件的建议支持无并发症和有并发症的阑尾炎手术治疗，延迟（>12h）或立即手术（<12h），单纯吸引灌洗或吸引，不常规放置引流管，术后短期抗生素治疗复杂性阑尾炎，和既往接受过非手术治疗的复杂性阑尾炎行间隔阑尾切除术。有条件的建议表明，遵守建议的益处可能超过危害，尽管它也表明了不确定性。
结论：这些建议应该为当前阑尾炎的争议提供指导。该小组还强调了今后可以加强证据基础的研究机会。