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Stefany Carolina Alvarado Rodríguez
Fausto Marcelo Quichimbo Sangurima

La apendicitis aguda es una de las emergencias más comunes en todo el mundo, tiene una alta prevalencia entre los jóvenes de 20 a 30 años, siendo menos frecuente en el adulto mayor. La apendicitis se presenta como un dolor e inflación del apéndice cecal. Tanto el tratamiento quirúrgico y no quirúrgico (antibioticoterapia) ha evolucionado muchos en los últimos años. Objetivo. Determinar la relación con apendicitis aguda, manejo quirúrgico vs antibiótico como opción de tratamiento; de esta forma dar un adecuado abordaje al paciente hospitalizado y las posibles alternativas terapéuticas de acuerdo a la condición y estado de enfermedad. Metodología. Se realizó una revisión sistemática bajo la búsqueda de información en las siguientes bases de datos: “PubMed, Scopus” y “Google Scholar” incluyendo artículos originales, experimentales, metaanálisis y páginas oficiales con temas relacionados al manejo quirúrgico y antibioticoterapia en apendicitis aguda. Para una búsqueda más exhaustive se utilizó en siguiente algoritmo: (Appendicitis) AND (acute) and (management) AND (surgical) AND (antibiotic). Conclusión. Las evidencias actuales de los diferentes estudios analizados demuestran que la apendicectomía laparoscópica es el tratamiento de elección más efectico para la apendicitis aguda complicada, asociado a una recuperación más rápida disminuyendo significativamente el riesgo de infecciones y mortalidad posterior a la cirugía, sin embargo, la asociación Americana de Cirugía y la Sociedad Mundial de Cirugía de emergencia recomiendan como alternativa terapéutica el tratamiento farmacológico con antibióticos de amplio espectro en pacientes con apendicitis aguda no complicada.

Acute appendicitis is one of the most common emergencies worldwide, it has a high prevalence among young people aged 20 to 30 years, being less frequent in older adults. Appendicitis presents as pain and inflation of the cecal appendix. Both surgical and non-surgical treatment (antibiotic therapy) has evolved a lot in recent years. Objective. To determine the relationship with acute appendicitis, surgical vs antibiotic management as a treatment option; in this way to give an adequate approach to the hospitalized patient and the possible therapeutic alternatives according to the condition and state of the disease. Methodology. A systematic review was carried out by searching for information in the following databases: "PubMed, Scopus" and "Google Scholar" including original articles, experimental, meta-analysis and official pages with topics related to surgical management and antibiotic therapy in acute appendicitis. For a more exhaustive search we used the following algorithm: (Appendicitis) AND (acute) and (management) AND (surgical) AND (antibiotic). Conclusion. Current evidence from the different studies analyzed shows that laparoscopic appendectomy is the most effective treatment of choice for complicated acute appendicitis, associated with a faster recovery and a significantly decreased risk of infection and mortality after surgery. However, the American Surgical Association and the World Society for Emergency Surgery recommend pharmacological treatment with broad-spectrum antibiotics in patients with uncomplicated acute appendicitis as a therapeutic alternative.

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Alvarado Rodríguez, S. C., & Quichimbo Sangurima, F. M. (2023). Apendicitis aguda: manejo quirúrgico vs antibiótico como opción de tratamiento. Revista Vive, 6(16), 45–54. https://doi.org/10.33996/revistavive.v6i16.205
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Biografía del autor/a

Stefany Carolina Alvarado Rodríguez, Universidad Católica de Cuenca. Cuenca, Ecuador

Médico interno de la carrera de medicina, Universidad Católica de Cuenca, Ecuador.

Fausto Marcelo Quichimbo Sangurima, Universidad Católica de Cuenca. Cuenca, Ecuador

Doctor en medicina y cirugía, Universidad Católica de Cuenca. Especialista en cirugía general, Universidad de Cuenca. Doctor en medicina y cirugía, Universidad de Cuenca. Tecnólogo médico en laboratorio clínico, Universidad de Cuenca, Ecuador.

Referencias

Urbina VG, Vázquez SR, Gutiérrez MT. revista medica sinergia. Rev Medica Sinerg [Internet]. 2019 Dec 1 [cited 2022 Nov 22];4(12):e316–e316. Available from: https://revistamedicasinergia.com/index.php/rms/article/view/316/673

Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: Modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015 Sep 26;386(10000):1278–87, doi: 10.1016/j.anireprosci.2015.05.005.

Gomes CA, Abu-Zidan FM, Sartelli M, Coccolini F, Ansaloni L, Baiocchi GL, et al. Management of Appendicitis Globally Based on Income of Countries (MAGIC) Study. World J Surg [Internet]. 2018 Dec 1 [cited 2022 Nov 22];42(12):3903–10. Available from: https://pubmed.ncbi.nlm.nih.gov/30006833/

Livingston EH, Woodward WA, Sarosi GA, Haley RW. Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management. Ann Surg [Internet]. 2007 Jun [cited 2022 Nov 22];245(6):886–92. Available from: https://pubmed.ncbi.nlm.nih.gov/17522514/

Camas y Egresos Hospitalarios | [Internet]. [cited 2022 Nov 22]. Available from: https://www.ecuadorencifras.gob.ec/camas-y-egresos-hospitalarios/

Ding W, Du Z, Zhou X. Endoscopic retrograde appendicitis therapy for management of acute appendicitis. Surg Endosc. 2022 Apr 1;36(4):2480–7. Available from: http://doi.org/10.1016/S0749-0720(15)30346-7.

Stringer MD. Acute appendicitis. J Paediatr Child Health [Internet]. 2017 Nov 1 [cited 2022 Nov 22];53(11):1071–6. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jpc.13737

Podda M, Gerardi C, Cillara N, Fearnhead N, Gomes CA, Birindelli A, et al. Antibiotic Treatment and Appendectomy for Uncomplicated Acute Appendicitis in Adults and Children: A Systematic Review and Meta-analysis. Ann Surg [Internet]. 2019 Dec 1 [cited 2022 Nov 22];270(6):1028–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30720508

Yu MC, Feng Y jun, Wang W, Fan W, Cheng H tao, Xu J. Is laparoscopic appendectomy feasible for complicated appendicitis??A systematic review and meta-analysis. Int J Surg [Internet]. 2017 Apr 1 [cited 2022 Nov 22];40:187–97. Available from: https://pubmed.ncbi.nlm.nih.gov/28302449/

Harnoss JC, Zelienka I, Probst P, Grummich K, Müller-Lantzsch C, Harnoss JM, et al. Antibiotics Versus Surgical Therapy for Uncomplicated Appendicitis: Systematic Review and Meta-analysis of Controlled Trials (PROSPERO 2015: CRD42015016882). Ann Surg [Internet]. 2017 May 1 [cited 2022 Nov 22];265(5):889–900. Available from: https://pubmed.ncbi.nlm.nih.gov/27759621/

Sallinen V, Akl EA, You JJ, Agarwal A, Shoucair S, Vandvik PO, et al. Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis. Br J Surg [Internet]. 2016 May 1 [cited 2022 Nov 22];103(6):656–67. Available from: https://pubmed.ncbi.nlm.nih.gov/26990957/

Prechal D, Damirov F, Grilli M, Ronellenfitsch U. Antibiotic therapy for acute uncomplicated appendicitis: a systematic review and meta-analysis. Int J Color Dis 2019 346 [Internet]. 2019 Apr 19 [cited 2022 Nov 23];34(6):963–71. Available from: https://link.springer.com/article/10.1007/s00384-019-03296-0

Yang Z, Sun F, Ai S, Wang J, Guan W, Liu S. Meta-analysis of studies comparing conservative treatment with antibiotics and appendectomy for acute appendicitis in the adult. BMC Surg [Internet]. 2019 Aug 14 [cited 2022 Nov 23];19(1):1–10. Available from: https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-019-0578-5

Podda M, Gerardi C, Di Saverio S. Response to comment on “Antibiotic treatment and appendectomy for uncomplicated acute appendicitis in adults and children: A Systematic Review and Meta-analysis” by Minneci PC et al. Ann Surg [Internet]. 2019 Dec 1 [cited 2022 Nov 23];270(6):e122–3. Available from: https://journals.lww.com/annalsofsurgery/Fulltext/2019/12000/Antibiotic_Treatment_and_Appendectomy_for.17.aspx

Collard M, Lakkis Z, Loriau J, Mege D, Sabbagh C, Lefevre JH, et al. Antibiotics alone as an alternative to appendectomy for uncomplicated acute appendicitis in adults: Changes in treatment modalities related to the COVID-19 health crisis. J Visc Surg. 2020 Jun 1;157(3):S33–42. Available from: https://doi.org/10.1016/j.jviscsurg.2020.04.014

Yadao S, Lamture Y, Huse S. Uses of Antibiotics Alone in Case of Uncomplicated Appendicitis. Cureus [Internet]. 2022 Aug 27 [cited 2022 Nov 23];14(8). Available from: https://www.cureus.com/articles/110039-uses-of-antibiotics-alone-in-case-of-uncomplicated-appendicitis

Sohn M, Agha A, Bremer S, Lehmann KS, Bormann M, Hochrein A. Surgical management of acute appendicitis in adults: A review of current techniques. Int J Surg. 2017 Dec 1;48:232–9.

Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1). https://jamanetwork.com/journals/jama/article-abstract/2320315

Talan DA, Saltzman DJ, Deugarte DA, Moran GJ. Methods of conservative antibiotic treatment of acute uncomplicated appendicitis: A systematic review. J Trauma Acute Care Surg [Internet]. 2019 Apr 1 [cited 2022 Nov 23];86(4):722. Available from: /pmc/articles/PMC6437084/

Moris D, Paulson EK, Pappas TN. Diagnosis and Management of Acute Appendicitis in Adults: A Review. JAMA [Internet]. 2021 Dec 14 [cited 2022 Nov 23];326(22):2299–311. Available from: https://jamanetwork.com/journals/jama/fullarticle/2787111

Poprom N, Numthavaj P, Wilasrusmee C, Rattanasiri S, Attia J, McEvoy M, et al. The efficacy of antibiotic treatment versus surgical treatment of uncomplicated acute appendicitis: Systematic review and network meta-analysis of randomized controlled trial. Am J Surg. 2019 Jul 1;218(1):192–200. Available from: https://pubmed.ncbi.nlm.nih.gov/34905029/

Hansson J, Orner UK¨, Khorram-Manesh A, Solberg A, Lundholm K. Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. academic.oup.com [Internet]. [cited 2022 Nov 23]; Available from: https://academic.oup.com/bjs/article-abstract/96/5/473/6148309

Allievi N, Harbi A, Ceresoli M, Montori G, Poiasina E, Coccolini F, et al. Acute Appendicitis: Still a Surgical Disease? Results from a Propensity Score-Based Outcome Analysis of Conservative Versus Surgical Management from a Prospective Database. World J Surg. 2017 Nov 1;41(11):2697–705.

Vons C, Barry C, Maitre S, Pautrat K, Leconte M, Costaglioli B, et al. Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: An open-label, non-inferiority, randomised controlled trial. Lancet. 2011;377(9777):1573–9. https://www.sciencedirect.com/science/article/pii/S174391911400209X