Conservative treatment of acute appendicitis: heresy or an effective and acceptable alternative to surgery?

For more than a century, emergency appendectomy has been a ‘surgical dogma’ in the management of acute appendicitis (AA). During recent decades, however, there is an increasing body of evidence suggesting that selected patients with AA could be treated conservatively. This approach has many advantages, including high success and low recurrence rates, reduced morbidity and mortality, less pain, shorter hospitalization and sick leave, and reduced costs. Despite that conservative management of AA cannot be used for all patients with AA (for example, in the presence of peritonitis), it could be preferred in a large percentage of patients with mild infection (as evidenced by clinical, laboratory, and imaging findings).