Current Management of Uncomplicated Acute Appendicitis: A Narrative Review of Nonoperative and Surgical Strategies.

Acute appendicitis remains one of the most common surgical emergencies worldwide and has traditionally been treated with appendectomy. However, growing evidence from randomized trials and international guidelines has challenged this paradigm, suggesting that nonoperative management with antibiotics may be a safe alternative for selected patients with uncomplicated disease. This narrative review aims to examine the current evidence on the management of uncomplicated acute appendicitis, with particular focus on the role of antibiotic therapy compared with surgical appendectomy, patient selection, and clinical outcomes. A narrative review of the literature was conducted using major medical databases, including PubMed, Scopus, and Google Scholar. Randomized clinical trials, systematic reviews, meta-analyses, and international guidelines published in recent years were analyzed to summarize current diagnostic strategies and treatment approaches for uncomplicated acute appendicitis. Recent studies demonstrate that antibiotic therapy can successfully treat a substantial proportion of patients with uncomplicated appendicitis, potentially avoiding immediate surgery. Nevertheless, nonoperative management is associated with higher rates of recurrence and subsequent appendectomy. The presence of an appendicolith has been consistently identified as a significant predictor of treatment failure. Laparoscopic appendectomy remains a safe and definitive treatment with low complication rates and minimal risk of recurrence. The management of uncomplicated acute appendicitis is evolving from a strictly surgical disease to a condition with multiple evidence-based treatment options. While appendectomy remains the definitive therapy, antibiotic treatment represents a feasible alternative in carefully selected patients. A patient-centered approach that incorporates imaging findings, clinical risk factors, and shared decision-making is essential for optimal outcomes.