Issue 10/2025
El-Tal, L.
Clinic of Hepato-Biliary, Pancreatic and General Surgery – Sofia
Acibadem City Clinic Tokuda Hospital
Introduction: Acute appendicitis is the most common non-obstetric surgical emergency and a leading cause of acute surgical abdomen, remaining a diagnostic and therapeutic challenge. Objective: To analyze contemporary approaches in the diagnosis and treatment of acute appendicitis, with a comparison between laparoscopic and open surgery, the role of antibiotics, and specific considerations in high-risk groups. Materials and Methods: Systematic reviews, meta-analyses, and international guidelines (SAGES, EAES) were reviewed, covering clinical forms, diagnostic algorithms (Alvarado), laboratory and imaging methods, as well as surgical techniques. Results: Diagnosis is based on clinical, laboratory, and imaging data. Laparoscopic appendectomy is established as the gold standard, associated with lower morbidity and faster recovery, while open surgery retains its role in complicated cases and in conversion. Laparoscopy is safe in pregnant, immunosuppressed, and transplanted patients. Antibiotic therapy provides short-term benefits but carries a high risk of recurrence. Discussion: Laparoscopy outperforms open surgery both clinically and economically. Conversion is a safe option, and the management of high-risk groups requires a multidisciplinary and individualized approach. Antibiotic therapy remains a controversial reserve method. Conclusion: Timely diagnosis, individualized surgical choice, and a multidisciplinary approach are key to achieving optimal outcomes. Laparoscopic appendectomy is the method of choice, while open surgery and antibiotic therapy remain valid options in selected cases.
Key words: acute appendicitis, laparoscopic appendectomy, open appendectomy.
Address for correspondence:
Dr. Lyuben El Tal
Clinic of Hepatobiliary, Pancreatic and General Surgery
51B „N. Vaptsarov”, Blvd., 4th floor.
1407, Sofia