Medical Science Research Bulletin

An interval appendectomy is performed following completion of non-operative treatment of complicated appendicitis to prevent recurrence. Interval appendectomy is usually performed 8 to 12 weeks after the completion of non-operative treatment, and it can be performed as an open or laparoscopic procedure. Recent evidence has questioned the need for performing an interval appendectomy due to the low recurrence rate following non-operative treatment, and interval appendectomy is also associated with some morbidity from the procedure. In this review, we will look at the indications for interval appendectomy in complicated and uncomplicated appendicitis and the risk factors for performing this procedure.

Acute Appendicitis, Complicated Appendicitis, non-operative treatment, Delayed appendectomy, Interval appendectomy, laparoscopic appendectomy.

1. Akingboye, A. A., Mahmood, F., Zaman, S., Wright, J., Mannan, F., & Mohamedahmed, A. Y. Y. (2021). Early versus delayed (interval) appendicectomy for the management of appendicular abscess and phlegmon: a systematic review and meta-analysis. Langenbeck’s Archives of Surgery, 406(5), 1341–1351. https://doi.org/10.1007/s00423-020-02042-3
2. Bass, J., Rubin, S., & Hummadi, A. (2006). Interval appendectomy: an old new operation. Journal of Laparoendoscopic & Advanced Surgical Techniques, 16(1), 67-69.
3. Becker, P., Fichtner-Feigl, S., & Schilling, D. (2018). Clinical management of appendicitis. Visceral Medicine, 34(6), 453–458. https://doi.org/10.1159/000494883
4. Bufo, A. J., Shah, R. S., Li, M. H., Cyr, N. A., Hollabaugh, R. S., Hixson, S. D., ... & Lobe, T. E. (1998). Interval appendectomy for perforated appendicitis in children. Journal of Laparoendoscopic & Advanced Surgical Techniques, 8(4), 209-214.
5. Coccolini, F., Fugazzola, P., Sartelli, M., Cicuttin, E., Sibilla, M. G., Leandro, G., De’angelis, G. L., Gaiani, F., Di Mario, F., Tomasoni, M., Catena, F., & Ansaloni, L. (2018). Conservative treatment of acute appendicitis. In Acta Biomedica (Vol. 89, pp. 119–134). Mattioli 1885. https://doi.org/10.23750/abm.v89i9-S.7905
6. Corfield, L. (2007). Interval appendicectomy after appendiceal mass or abscess in adults: What is “best practice”? In Surgery Today (Vol. 37, Issue 1, pp. 1–4). https://doi.org/10.1007/s00595-006-3334-2
7. Dahiya, D. S., Akram, H., Goyal, A., Khan, A. M., Shahnoor, S., Hassan, K. M., Gangwani, M. K., Ali, H., Pinnam, B. S. M., Alsakarneh, S., Canakis, A., Sheikh, A. B., Chandan, S., & Sohail, A. H. (2024). Controversies and Future Directions in Management of Acute Appendicitis: An Updated Comprehensive Review. In Journal of Clinical Medicine (Vol. 13, Issue 11). Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/jcm13113034
8. Darwazeh, G., Cunningham, S. C., & Kowdley, G. C. (2016). A systematic review of perforated appendicitis and phlegmon: interval appendectomy or wait-and-see?. The American Surgeon, 82(1), 11-15.
9. Di Saverio, S., Podda, M., De Simone, B., Ceresoli, M., Augustin, G., Gori, A., Boermeester, M., Sartelli, M., Coccolini, F., Tarasconi, A., De’ Angelis, N., Weber, D. G., Tolonen, M., Birindelli, A., Biffl, W., Moore, E. E., Kelly, M., Soreide, K., Kashuk, J., … Catena, F. (2020). Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. In World Journal of Emergency Surgery (Vol. 15, Issue 1). BioMed Central Ltd. https://doi.org/10.1186/s13017-020-00306-3
10. Garba, E. S., & Ahmed, A. (2008). Management of appendiceal mass. Annals of African Medicine, 7(4), 200–204. https://doi.org/10.4103/1596-3519.55652
11. Gorter, R. R., Eker, H. H., Gorter-Stam, M. A. W., Abis, G. S. A., Acharya, A., Ankersmit, M., Antoniou, S. A., Arolfo, S., Babic, B., Boni, L., Bruntink, M., van Dam, D. A., Defoort, B., Deijen, C. L., DeLacy, F. B., Go, P. M., Harmsen, A. M. K., van den Helder, R. S., Iordache, F., … Bonjer, J. (2016). Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surgical Endoscopy, 30(11), 4668–4690. https://doi.org/10.1007/s00464-016-5245-7
12. Hall, N. J., Eaton, S., Stanton, M. P., Pierro, A., & Burge, D. M. (2017). Active observation versus interval appendicectomy after successful non-operative treatment of an appendix mass in children (CHINA study): an open-label, randomised controlled trial. The Lancet Gastroenterology and Hepatology, 2(4), 253–260. https://doi.org/10.1016/S2468-1253(16)30243-6
13. Hall, N. J., Jones, C. E., Eaton, S., Stanton, M. P., & Burge, D. M. (2011). Is interval appendicectomy justified after successful nonoperative treatment of an appendix mass in children? A systematic review. In Journal of Pediatric Surgery (Vol. 46, Issue 4, pp. 767–771). W.B. Saunders. https://doi.org/10.1016/j.jpedsurg.2011.01.019
14. Huang, L., Yin, Y., Yang, L., Wang, C., Li, Y., & Zhou, Z. (2017). Comparison of antibiotic therapy and appendectomy for acute uncomplicated appendicitis in children a meta-analysis. JAMA Pediatrics, 171(5), 426–434. https://doi.org/10.1001/jamapediatrics.2017.0057
15. Kaminski, A., Liu, I. L. A., Applebaum, H., Lee, S. L., & Haigh, P. I. (2005). Routine interval appendectomy is not justified after initial nonoperative treatment of acute appendicitis. Archives of Surgery, 140(9), 897-901.
16. Kanaka, S., Mizutani, S., Yokoyama, Y., Matsutani, T., Chihara, N., Katsuno, A., Takata, H., Nakata, R., Mishima, K., Wada, Y., Shimizu, T., Yamagiwa, R., Haruna, T., Nakamura, Y., Hamaguchi, A., Taniai, N., & Yoshida, H. (2022). Periappendiceal fluid collection on preoperative computed tomography can be an indication for interval appendectomy: a retrospective study. World Journal of Emergency Surgery, 17(1). https://doi.org/10.1186/s13017-022-00437-9
17. Khan, M. S., Siddiqui, M. T. H., Shahzad, N., Haider, A., Chaudhry, M. B. H., & Alvi, R. (2019). Factors Associated with Complicated Appendicitis: View from a Low-middle Income Country. Cureus. https://doi.org/10.7759/cureus.4765
18. Kojima, D., Leppäniemi, A., & Hasegawa, S. (2019). Acute Appendicitis. Journal of Acute Care Surgery, 9(2), 31–34. https://doi.org/10.17479/jacs.2019.9.2.31
19. Kumar, S. S., Collings, A. T., Lamm, R., Haskins, I. N., Scholz, S., Nepal, P., ... & Slater, B. J. (2024). SAGES guideline for the diagnosis and treatment of appendicitis. Surgical endoscopy, 38(6), 2974-2994.//doi.org/10.1007/s00464-024-10813-y
20. Lai, H. W., Loong, C. C., Wu, C. W., & Lui, W. Y. (2005). Watchful waiting versus interval appendectomy for patients who recovered from acute appendicitis with tumor formation: A cost-effectiveness analysis. Journal of the Chinese Medical Association, 68(9), 431–434. https://doi.org/10.1016/S1726-4901(09)70159-5
21. Lee, H. G., & Park, I. J. (2025). Clinical outcomes and optimal indications for nonoperative management of acute appendicitis in adult patients: a comprehensive literature review. In Annals of Coloproctology (Vol. 41, Issue 2, pp. 107–118). Korean Society of Coloproctology. https://doi.org/10.3393/ac.2023.00192.0027
22. Liew, A. N., Tomar, A., Rajagopalan, A., Tan, R. Y. M., Chen, M. Z., & Tay, Y. K. (2024). Management of Inflammatory Phlegmon in Appendicitis: Comparing the Role of Emergency vs. Interval Appendectomy at a Single Institution. Cureus. https://doi.org/10.7759/cureus.73801
23. Oktay, C., Goksu, M., & Yavuz, S. (2023). Prevalence of appendicolith in children with acute appendicitis and its correlation with disease severity. Northern Clinics of Istanbul, 10(5), 631–635. https://doi.org/10.14744/NCI.2022.67984
24. Peltrini, R., Cantoni, V., Green, R., Lionetti, R., D’Ambra, M., Bartolini, C., De Luca, M., Bracale, U., Cuocolo, A., & Corcione, F. (2021). Risk of appendiceal neoplasm after interval appendectomy for complicated appendicitis: A systematic review and meta-analysis. In Surgeon (Vol. 19, Issue 6, pp. e549–e558). Elsevier Ltd. https://doi.org/10.1016/j.surge.2021.01.010
25. Perez, K. S., & Allen, S. R. (2018). Complicated appendicitis and considerations for interval appendectomy. Journal of the American Academy of Physician Assistants, 31(9), 35–41. https://doi.org/10.1097/01.JAA.0000544304.30954.40
26. Quartey, B. (2012). Interval appendectomy in adults: A necessary evil. In Journal of Emergencies, Trauma and Shock (Vol. 5, Issue 3, pp. 213–216). https://doi.org/10.4103/0974-2700.99683
27. Rashid, A., Nazir, S., Kakroo, S. M., Chalkoo, M. A., Razvi, S. A., & Wani, A. A. (2013). Laparoscopic Interval Appendectomy Versus Open Interval Appendectomy: A Prospective Randomized Controlled Trial. In Surg Laparosc Endosc Percutan Tech (Vol. 23, Issue 1). www.surgical-laparoscopy.com|93
28. Sakorafas, G. H. (2012). Interval routine appendectomy following conservative treatment of acute appendicitis: Is it really needed. World Journal of Gastrointestinal Surgery, 4(4), 83. https://doi.org/10.4240/wjgs.v4.i4.83
29. Singh, M., Kadian, Y., Rattan, K., & Jangra, B. (2014). Complicated appendicitis: Analysis of risk factors in children. African Journal of Paediatric Surgery, 11(2), 109–113. https://doi.org/10.4103/0189-6725.132796
30. Sula, S., Paananen, T., Tammilehto, V., Hurme, S., Mattila, A., Rantanen, T., Rautio, T., Pinta, T., Sippola, S., Haijanen, J. M., & Salminen, P. (2024). Impact of an appendicolith and its characteristics on the severity of acute appendicitis. BJS Open, 8(5). https://doi.org/10.1093/bjsopen/zrae093
31. Taib, A. G., Kler, A., Prayle, M., Kanakalingam, D., Fani, M., & Asaad, P. (2024). Appendicolith appendicitis: should we be operating sooner? A retrospective cohort study. Annals of the Royal College of Surgeons of England, 106(3), 237–244. https://doi.org/10.1308/rcsann.2023.0055
32. Tannoury, J., & Abboud, B. (2013). Treatment options of inflammatory appendiceal masses in adults. World Journal of Gastroenterology, 19(25), 3942–3950. https://doi.org/10.3748/wjg.v19.i25.3942
33. Tekin, A., Kurtoǧlu, H. C., Can, I., & Öztan, S. (2008). Routine interval appendectomy is unnecessary after conservative treatment of appendiceal mass. Colorectal Disease, 10(5), 465–468. https://doi.org/10.1111/j.1463-1318.2007.01377.x
34. Tsai, H. M., Shan, Y. S., Lin, P. W., Lin, X. Z., & Chen, C. Y. (2006). Clinical analysis of the predictive factors for recurrent appendicitis after initial nonoperative treatment of perforated appendicitis. American Journal of Surgery, 192(3), 311–316. https://doi.org/10.1016/j.amjsurg.2005.08.037
35. Willemsen, P. J., Hoorntje, L. E., Eddes, E.-H., Ploeg, R. J., & Willemsen, P. (2002). The Need for Interval Appendectomy after Resolution of an Appendiceal Mass Questioned. In Dig Surg (Vol. 19). www.karger.com/journals/dsu