Controversies in appendicitis.

BACKGROUND Appendectomy for appendicitis is a common operation that is performed by most general surgeons. Despite the large number of appendectomies, numerous management controversies continue. METHODS Review of the pertinent English language literature. RESULTS Controversy persists regarding the use of imaging studies for diagnosis, laparoscopic vs. open surgical methods, nonoperative management of uncomplicated appendicitis, delayed management of the patient with phlegmon from severe appendicitis, the necessity for interval appendectomy, and the merits of deferral of off-hour appendectomy until the following morning. This review identifies the published reports that support the pros and cons of each controversy. CONCLUSIONS Class I data generally are lacking to support the resolution of these controversies. Additional well-controlled clinical trials are necessary to obtain definitive answers.