Published online Aug 28, 2017. doi: 10.3748/wjg.v23.i32.5849
Peer-review started: May 16, 2017
First decision: June 5, 2017
Revised: July 25, 2017
Accepted: August 1, 2017
Article in press: August 2, 2017
Published online: August 28, 2017
Processing time: 107 Days and 22 Hours
Acute appendicitis (AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy (LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Non-operative management of AA may be tolerated only in children. Postoperative complications increase according to the patient’s factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon’s skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner (i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.
Core tip: Acute appendicitis develops in a progressive and irreversible manner, and emergent laparoscopic appendectomy (LA) is mandatory. The Japanese government uses a universal health insurance system. Any physician and institution can routinely perform expensive emergent LA in Japan, in accordance with medical ethics. Unsafe, but cost-effective, treatments such as interval/delayed appendectomy and conservative management only are unsuitable in Japan. Time-honored practices, (i.e., emergent LA) should be respected in Japan.