SURGICAL MANAGEMENT OF ACUTE APPENDICITIS: WHEN TO INDICATE CONSERVATIVE TREATMENT?

Abstract

The management of acute appendicitis, traditionally focused on emergency appendectomy, has undergone significant paradigmatic shifts with the emergence of conservative treatment for uncomplicated cases. This study aimed to analyze current scientific evidence regarding the efficacy, safety, and indication criteria for exclusive antibiotic therapy instead of surgical intervention. To this end, an integrative literature review was conducted based on the PICO strategy, consulting PubMed, SciELO, and LILACS databases, with a timeframe between 2020 and 2026. The results indicate that conservative treatment presents initial success rates exceeding 70% in strictly selected patients, characterized by clinical stability and the absence of appendicoliths on imaging exams. It was observed that this modality offers immediate advantages, such as reduced surgical trauma, lower incidence of surgical site infections, and early return to daily activities. However, the long-term recurrence rate remains the primary limitation, requiring continuous clinical surveillance. It is concluded that non-operative treatment is a safe and effective alternative for a specific subgroup of patients, but the decision must be individualized and based on precise diagnostic criteria. Laparoscopic appendectomy maintains its position as the gold standard due to its definitive resolution; however, clinical management is established as an essential strategy in contemporary personalized medicine, especially where surgical risk is high or patient preference dictates.