Diagnosis and Treatment of Acute Appendicitis: 2025 Edition of the World Society of Emergency Surgery Jerusalem Guidelines

Front

1 of 3 · Front

📘 GuidelineCh 6 · Emergency, Trauma, Acute Care & Surgical Critical Care

Diagnosis and Treatment of Acute Appendicitis: 2025 Edition of the World Society of Emergency Surgery Jerusalem Guidelines

In one breath

The 2025 Jerusalem update for acute appendicitis: 35 GRADE recommendations over 19 questions — risk scores and imaging first, antibiotics alone only for selected uncomplicated cases, laparoscopic appendectomy as the standard operation, and 2–3 days of postoperative antibiotics in complicated disease.

Edition2025 Edition

Issued byWorld Society of Emergency Surgery (WSES)

Place of issueInternational

PublishedJAMA Surgery · 2026;161(3):283–295

⏳ Pending verification

FACE COLOURS Front — the summary · Back 1 — what it covers + key recommendations · Back 2 — evidence, changes + source

Back 1

2 of 3 · Back 1

Back colours mark the reading sections — the chapter colour is the band and chip.

§1 · What it covers

This guideline covers the diagnosis and treatment of acute appendicitis — uncomplicated and complicated, including complicated appendicitis with abscess managed nonoperatively — across the populations the panel addressed directly.

Applies to: Adults and children with suspected, uncomplicated, or complicated acute appendicitis; recommendations are tailored for pregnant women, older patients (aged ≥65 years), immunocompromised individuals, and patients with obesity (BMI ≥30).

§2 · Key recommendations

Use clinical risk scores and imaging to improve diagnostic accuracy and reduce negative appendectomy rates.
Offer nonoperative management with antibiotics to selected patients with uncomplicated appendicitis, after shared decision-making; tailor the choice to the specific population.
Appendectomy for uncomplicated appendicitis may be safely delayed within 24 hours without increased risk of adverse outcomes.
Laparoscopic appendectomy remains the standard surgical approach.
Limit postoperative antibiotic therapy to short courses (2–3 days) in complicated disease with adequately controlled infection.
After nonoperative management of complicated appendicitis with abscess, follow up to detect neoplasms.

FACE COLOURS Front — the summary · Back 1 — what it covers + key recommendations · Back 2 — evidence, changes + source

Back 2

3 of 3 · Back 2

Back colours mark the reading sections — the chapter colour is the band and chip.

§3 · Evidence & grading

Graded with GRADE. The panel answered 19 key clinical questions in 6 domains and issued 35 recommendations, each rated for certainty of evidence (high, moderate, low, or very low) and strength (strong or conditional). The evidence review searched MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library to May 2025; risk of bias was assessed with RoB-2, ROBINS-I, and QUADAS-2. Per-recommendation certainty and strength ratings: Not yet established — pending verification (full-text pass).

§4 · What changed in this edition

Compared with the previous Jerusalem edition, the 2025 update re-searches the evidence to May 2025 and issues 35 recommendations across 19 questions, with recommendations tailored to specific populations (pregnancy, age ≥65 years, immunocompromise, obesity). A recommendation-by-recommendation change table: Not yet established — pending verification (full-text pass).

§5 · Source & working link

Podda M, et al. Diagnosis and Treatment of Acute Appendicitis: 2025 Edition of the World Society of Emergency Surgery Jerusalem Guidelines. JAMA Surg. 2026;161(3):283–295. doi:10.1001/jamasurg.2025.6218 · PMID 41604201.

Publisher — JAMA Surgery (record's original_url, verbatim) ↗DOI — 10.1001/jamasurg.2025.6218 ↗PubMed — PMID 41604201 ↗

Link check 2026-11-11 (re-checked at Wave D build; first checked 2026-11-10 for the ruled sample): PubMed record fetched live — title, journal, volume/pages, DOI and PMID all match the source record; the DOI also resolved at Crossref with the same details. The publisher URL returned HTTP 403 to automated fetching (publisher bot protection, not a dead link); carried verbatim per the record and marked publisher-fetch-blocked (spec §5.6), with DOI and PubMed rows verified instead.

Source: Tamer-supplied guideline index, intake 2026-11-10 (record #1, Domain 01) · This is the ruled format-reference card (sample-wses-appendicitis + sample-triangle), shipped in Wave D (2026-11-11) with its division re-based to the 16-division registry (Division 6; the staged sample carried the pre-Wave-A chapter number). The §5.2 verification pass (UpToDate + Medscape → Perplexity → Tamer decision) has not yet run on this card. Completed in verification: publication, summary / keyRecommendations / evidence — PubMed record PMID 41604201, fetched live 2026-11-10; Published abstract, PubMed PMID 41604201, fetched live 2026-11-10. ⚑ Conflict flag on the source record — documented cross-society disagreement (intake DOCX Table 2): Appendicitis — WSES Jerusalem 2025 edition (published 2026) vs SAGES appendicitis guideline (2023): operative vs antibiotic-first pathways. Unresolved — pending the verification pass (UpToDate + Medscape → Perplexity → Tamer decision).

FACE COLOURS Front — the summary · Back 1 — what it covers + key recommendations · Back 2 — evidence, changes + source

gl-div06-wses-appendicitis-2025GS.code · Guidelines

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