Appendicitis is a common condition, occurring in 250,000 patients every year in the United States and accounting for an estimated 1 million hospital days per year. Acute appendicitis is the most common cause of an acute abdomen that requires surgical treatment. A diagnosis can be made on clinical grounds in most patients, but imaging studies are useful in patients with equivocal findings. Prompt diagnosis and surgical treatment are the cornerstones of therapy to preempt progression of the disease to perforation that is associated with increased morbidity. Both laparoscopic and open appendectomy are viable surgical options, with most recent studies suggesting more favorable outcomes with a laparoscopic approach. In practice, the choice for either is usually based on the expertise of the surgeon along with the availability of hospital resources. The precise etiology of appendicitis is unclear. Accordingly, surgeons will continue to evaluate and treat patients with appendicitis for the foreseeable future. The liberal use of imaging modalities to improve the accuracy of preoperative diagnosis and minimize the negative appendectomy rate is a trend that is likely to continue. Operating on a patient without an imaging examination may often be appropriate, but will be the exception, not the rule. Finally, the trend toward laparoscopy is relatively slow compared with its adoption for the surgical treatment of other diseases, but inexorable. It would not be surprising if laparoscopic appendectomy becomes the most popular treatment for appendicitis in the future.
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