Guideline / position statementindependent cross-checkabstract checked★ key study I-ORG-109 in-depth review
International guideline on appendicitis (2025)
Diagnosis and Treatment of Acute Appendicitis: 2025 Edition of the World Society of Emergency Surgery Jerusalem Guidelines.
Overview
Podda M et al.. JAMA Surg 2026 · PMID 41604201 · DOI 10.1001/jamasurg.2025.6218
Antibiotics can be used in selected simple cases and better diagnosis reduces unnecessary operations, but surgery remains the standard treatment.
Does the study support the specific claim? Partly · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Give evidence-based advice for appendicitis care
- How was the study done?
GRADE-based international guideline
- How many people, animals or samples were studied?
19 questions, 35 recommendations
- What was actually found?
Antibiotics an option in selected cases; laparoscopic surgery standard
- How large was the observed effect?
n/a
- What do the results mean in everyday life?
Both treatments are accepted; appendicitis must be treated
- What are the study's limitations?
Full text not read
- What does it say about Elawady's specific claim?
Partly supports avoiding unnecessary removal
- Do the results apply to Germany and Europe?
Applies in Europe and elsewhere
- What can explicitly not be concluded from this study?
Not about diet
Scientific in-depth review
1. Full reference
- Authors
- Podda M et al.
- Journal
- JAMA Surg
- Year
- 2026
- Identifier
- PMID 41604201 DOI 10.1001/jamasurg.2025.6218
- Verification
- verified – PubMed efetch 2026-10-26; Crossref works API 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Not stated in abstract.
2. Research question
Updated recommendations for diagnosis and treatment of acute appendicitis in adults, children, pregnant women, older, immunocompromised and obese patients.
3. Study design and population
- Study design
- Guideline / position statement – International clinical practice guideline (WSES Jerusalem guidelines, 2025 edition), GRADE-based
- Population
Patients with acute appendicitis
- Country
International (WSES)
- Period
Literature to May 2025
- Sample size
19 key questions; 35 recommendations
- Inclusion and exclusion criteria
RCTs, observational studies, systematic reviews; RoB-2, ROBINS-I, QUADAS-2
4. Methods and endpoints
- Exposure / intervention
Diagnostic and treatment strategies
- Comparator
n/a
- Endpoints
Recommendations
- Statistical methods
GRADE evidence profiles and evidence-to-decision frameworks
5. Actual results
- Results
Key findings (abstract): clinical risk scores and imaging improve diagnostic accuracy and reduce negative appendectomy rates; non-operative management with antibiotics is safe and effective in selected patients with uncomplicated appendicitis, with recommendations tailored to populations; appendectomy for uncomplicated appendicitis may be delayed within 24 hours; laparoscopic appendectomy remains the standard surgical approach; short postoperative antibiotics in complicated disease; follow-up after non-operative management of abscess to detect neoplasms. (The 2020 edition, full text read: NOM recommended as a safe alternative in selected adults without appendicolith [strong, high quality] and suggested in children without appendicolith [weak, moderate quality]; recurrence up to 39% at 5 years.)
- Absolute risks
Not applicable
- Authors' conclusion
The 2025 WSES guidelines aim to standardise practice and reduce unwarranted variability; implementation should be adapted to local resources.
6. Strengths
- GRADE methodology
- Recent (2025) literature search
- Population-specific recommendations
7. Weaknesses
- Full text not accessed (2025 edition)
- Consensus elements
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- not assessable
- Rationale
Guideline; AGREE II not formally applied.
9. Assessment of the statistical interpretation
Not applicable.
10. Relevance to the specific claim
Current international standard: both antibiotics-first (selected cases) and surgery are accepted; untreated appendicitis is not an option.
11. Independent contrary findings
n/a
12. Transferability to Germany and Europe
High; used across Europe.
13. Overall methodological judgement
Confirms that unnecessary removal can be reduced by better diagnosis and selected non-operative treatment, while surgery remains standard care.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | not assessable |
| Precision of results | not applicable |
| Directness | direct |
| Reproducibility | not replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Full text of 2025 recommendations for children not read.
15. Linked fact checks
- The appendix (like tonsils and adenoids) is removed far too readily from early childhood onward. – Studies supporting the claim
- No working organ should be removed (e.g., a thyroid with nodules that still functions); one should stay away from the scalpel, and Elawady is 'against any operation, including caesarean section'. – Studies contradicting or limiting the claim