MANAGEMENT OF COMPLICATED ACUTE APPENDICITIS: UPDATES ON SURGICAL AND THERAPEUTIC STRATEGIES

Abstract

Complicated acute appendicitis represents a significant surgical emergency associated with high morbidity, especially in cases of perforation, intra-abdominal abscess, and diffuse peritonitis. This study aimed to analyze the main updates related to the management of complicated acute appendicitis, focusing on contemporary surgical and therapeutic strategies. This is an integrative literature review conducted in the PubMed/MEDLINE, Virtual Health Library (VHL), SciELO, and Google Scholar databases, using descriptors related to complicated appendicitis, laparoscopy, antibiotic therapy, and surgical treatment. Studies published between 2019 and 2026, in Portuguese, English, and Spanish, were included. The results showed that videolaparoscopy has become the preferred approach due to reduced postoperative pain, shorter hospital stay, and faster functional recovery. In addition, conservative treatment with antibiotic therapy, with or without percutaneous drainage, proved effective in selected patients with appendiceal abscess or plastron. There has also been a growing appreciation for accelerated recovery protocols and the rational use of antimicrobials. It is concluded that the contemporary management of complicated acute appendicitis should be individualized and based on up-to-date scientific evidence, aiming at reducing morbidity and optimizing clinical outcomes.