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Metrics details. Acute appendicitis AA is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide.

In July , the World Society of Emergency Surgery WSES organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy.

Literature search has been updated up to and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation.

Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. The WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: 1 diagnosis, 2 non-operative management for uncomplicated AA, 3 timing of appendectomy and in-hospital delay, 4 surgical treatment, 5 intra-operative grading of AA, 6 ,management of perforated AA with phlegmon or abscess, and 7 peri-operative antibiotic therapy.