Journal article
Diagnosis and Treatment of Acute Appendicitis: 2025 Edition of the World Society of Emergency Surgery Jerusalem Guidelines
JAMA surgery
01/28/2026
DOI: 10.1001/jamasurg.2025.6218
PMID: 41604201
Abstract
Acute appendicitis is the most common abdominal surgical emergency worldwide and a leading cause of emergency hospital admissions and operations. Despite its frequency, substantial variability persists in diagnosis and management across patient populations and health care settings.
To provide updated, evidence-based recommendations for the diagnosis and treatment of acute appendicitis in adults, children, pregnant women, older patients (aged ≥65 years), immunocompromised individuals, and patients with obesity (body mass index ≥30), developed by the World Society of Emergency Surgery (WSES) using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
A systematic literature search was performed in MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library to identify relevant studies published until May 2025. Eligible designs included randomized clinical trials, observational studies, systematic reviews, and meta-analyses. Risk of bias was assessed with design-appropriate tools (RoB-2, ROBINS-I, QUADAS-2). Evidence profiles and evidence-to-decision frameworks were generated for each of 19 key clinical questions. The certainty of evidence was rated as high, moderate, low, or very low. Recommendations were classified as strong or conditional (weak) according to GRADE.
Six key clinical domains were addressed across 19 questions. Thirty-five recommendations were formulated. Key findings include: (1) clinical risk scores and imaging improve diagnostic accuracy and reduce negative appendectomy rates; (2) nonoperative management with antibiotics is safe and effective in selected patients with uncomplicated appendicitis, with recommendations tailored for specific populations; (3) appendectomy for uncomplicated appendicitis may be safely delayed within 24 hours without increased risk of adverse outcomes; (4) laparoscopic appendectomy remains the standard surgical approach; (5) postoperative antibiotic therapy should be limited to short courses (2-3 days) in complicated disease; and (6) follow-up strategies are essential after nonoperative management of complicated appendicitis with abscess to detect neoplasms.
The 2025 WSES Jerusalem Guidelines provide updated, evidence-based recommendations for the diagnosis and treatment of acute appendicitis with the aim to standardize practice, reduce unwarranted variability, and support safe, effective, and patient-centered care across diverse populations and health care systems. Their implementation should be adapted to local resources.
Details
- Title: Subtitle
- Diagnosis and Treatment of Acute Appendicitis: 2025 Edition of the World Society of Emergency Surgery Jerusalem Guidelines
- Creators
- Mauro Podda - University of CagliariMarco Ceresoli - University of Milano-BicoccaBelinda De Simone - Department of Minimally Invasive, General and Emergency Surgery, Infermi Hospital, Rimini, ItalyPaola Fugazzola - University of PaviaFrancesco Pata - University of CalabriaAndrea Balla - Hospital Universitario Virgen MacarenaChiara Gerardi - Mario Negri Institute for Pharmacological ResearchEleonora Allocati - Mario Negri Institute for Pharmacological ResearchPaulina Salminen - Turku University HospitalRaul Coimbra - Riverside University Health System - Medical CenterMichael Kelly - Albury Wodonga HealthMarja Boermeester - Amsterdam University Medical CentersHelmut Segovia Lohse - Hospital de ClínicasEdward Tan - Radboud University Medical CenterAdolfo Pisanu - University of CagliariFikri Abu-Zidan - United Arab Emirates UniversityDavid Flum - University of WashingtonBoris Sakakushev - Medical University PlovdivLuca Ansaloni - University of PaviaCarlos Augusto Gomes - Faculdade de Medicina do ABCDavid Talan - Ronald Reagan UCLA Medical CenterGiovanni Domenico Tebala - Azienda Ospedaliera S.MariaVishal Shelat - Tan Tock Seng HospitalCino Bendinelli - John Hunter HospitalZsolt Balogh - John Hunter HospitalPanu Mentula - Helsinki University HospitalIsidoro Di Carlo - Ospedale CannizzaroYoram Kluger - Lev Hasharon HospitalMatti Tolonen - University of HelsinkiHenna Sammalkorpi - Helsinki University HospitalDimitrios Damaskos - Edinburgh Royal InfirmaryWalter Biffl - Scripps Clinic Medical GroupBaohong Yang - Weifang People's HospitalVille Sallinen - Helsinki University HospitalJustin Davies - Addenbrooke's HospitalCarlo Vallicelli - Department of General, Emergency and Trauma Surgery, Maurizio Bufalini Hospital, Cesena, ItalyFrancesco Amico - John Hunter HospitalGoran Augustin - University Hospital Centre ZagrebEugenio Cucinotta - Azienda Ospedaliera Universitaria Policlinico "G. Martino"Andrey Litvin - Gomel State Medical UniversityAndrew Kirkpatrick - Foothills Medical CentreNicola de'Angelis - General Surgery Department, Fondazione Poliambulanza, Brescia, ItalyDieter Weber - The University of Western AustraliaAri Leppaniemi - Helsinki University HospitalMatthew Lee - University of BirminghamLuis Felipe Cabrera Vargas - Fundación Santa Fe de BogotáMassimo Sartelli - Ospedale di MacerataFederico Coccolini - University of PisaSalomone Di Saverio - Department of General Surgery, Madonna del Soccorso Hospital, San Benedetto del Tronto, ItalyFausto Catena - Ospedale “M. Bufalini” di Cesena
- Resource Type
- Journal article
- Publication Details
- JAMA surgery
- DOI
- 10.1001/jamasurg.2025.6218
- PMID
- 41604201
- ISSN
- 2168-6262
- eISSN
- 2168-6262
- Publisher
- American Medical Association
- Language
- English
- Electronic publication date
- 01/28/2026
- Academic Unit
- Emergency Medicine; Internal Medicine
- Record Identifier
- 9985132206102771
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