{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T07:07:28Z","timestamp":1783840048387,"version":"3.55.0"},"reference-count":17,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Appendectomy is the current standard of care for acute appendicitis. However, accumulating international evidence suggests that medical antibiotic therapy is not inferior to appendectomy. Local factors may work for and against a medical approach. While prospective randomized trials are still to be performed in a South African setting, this study aimed to describe existing data within a geographically defined area.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A retrospective audit from 01\/01\/2018\u201331\/12\/2023 was performed at George Regional Hospital, South Africa. All adults and children over 12\u00a0years with a clinical or radiological diagnosis of acute appendicitis, without complicated disease mandating direct surgical appendectomy, were identified and separated into two groups, namely, those with initial medical management and those who underwent direct appendectomy. The primary aims were to compare the presentations and outcomes of acute appendicitis managed by antibiotic therapy or appendectomy. Secondary aims included describing the proportion of cases eligible for medical management, as well as post\u2010treatment complications, including the recurrence rate. Analysis was descriptive and comparative with patients grouped as Direct Surgery (DS), Antibiotics Successful (AS) and Antibiotics Unsuccessful (AU).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Direct surgical appendectomy was performed on 44% of the 650 cases. Of 365 (56%) cases that received antibiotic therapy, 190 (52%) were discharged without symptoms (AS), while 175 (48%) failed antibiotic therapy and underwent surgical appendectomy (AU) during first admission. Of the 190 patients who were discharged after antibiotic therapy only, 16 had recurrent symptoms, of which 14 underwent surgery and 2 had repeat antibiotic therapy. When comparing the AS to AU group, AS cases had a lower median heart rate (89 vs. 95 bpm;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05), lower C\u2010reactive protein level (51 vs. 108\u00a0mg\/L;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01) and lower Alvarado score (6 vs. 7;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01). Patients in the AS group had a median hospitalization of one day less than the DS group (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), and two\u00a0days less than the AU group (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). When compared with DS, patients in the AU group experienced significantly fewer (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) Clavien\u2010Dindo grade 3\u20135 events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Half of patients with acute appendicitis treated medically, safely avoided appendectomy. In this context, antibiotic therapy may be considered in selected patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70397","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T12:24:46Z","timestamp":1779193486000},"page":"1855-1861","source":"Crossref","is-referenced-by-count":1,"title":["Medical Versus Surgical Management of Acute Appendicitis in a Regional Hospital in South Africa: A Six\u2010Year Review"],"prefix":"10.1002","volume":"50","author":[{"given":"J. D.","family":"Hall","sequence":"first","affiliation":[{"name":"Department of Surgery University of Cape Town, Groote Schuur Hospital  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3265-1049","authenticated-orcid":false,"given":"D.","family":"Nel","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Cape Town, Groote Schuur Hospital  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. H.","family":"Stark","sequence":"additional","affiliation":[{"name":"Department of Surgery George Provincial Hospital  George South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0861-2939","authenticated-orcid":false,"given":"M.","family":"van de Vyver","sequence":"additional","affiliation":[{"name":"Experimental Medicine Research Group, Department of Medicine, Faculty of Medicine &amp; Health Sciences Stellenbosch University, Tygerberg Hospital  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Seedat","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2344-3969","authenticated-orcid":false,"given":"D. R.","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Stellenbosch University, Tygerberg Hospital  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a115734"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.6154"},{"issue":"3","key":"e_1_2_12_4_1","first-page":"334","article-title":"Antibiotics Alone for Uncomplicated Acute Appendicitis in the High Operative Risk Adult Patients: Analytical Review of Rcts and Proposal of Evidence\u2010Based Treatment Decisions","volume":"87","author":"Abongwa H. K.","year":"2016","journal-title":"Acta BioMedica"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010023\u201046172\u20102"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2014320"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.13201"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10873"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.36303\/sajs.02917"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.36303\/sajs.02918"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.36303\/sajs.02884"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/oby.2002.141"},{"key":"e_1_2_12_13_1","volume-title":"Mid\u2010Year Population Estimates","author":"Statistics South Africa","year":"2019"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0220202"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/20786204.2006.10873333"},{"key":"e_1_2_12_16_1","first-page":"E1","article-title":"Quality of Life and Patient Satisfaction at 7\u2010Year Follow\u2010Up of Antibiotic Therapy vs Appendectomy for Uncomplicated Acute Appendicitis: A Second Analysis of a Randomized Clinical Trial","author":"Sippola S.","year":"2020","journal-title":"JAMA Surgery"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2011.058"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13017\u2010015\u20100046\u20101"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70397","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/wjs.70397","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70397","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T06:10:08Z","timestamp":1783836608000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/wjs.70397"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,19]]},"references-count":17,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1002\/wjs.70397"],"URL":"https:\/\/doi.org\/10.1002\/wjs.70397","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,19]]}}}