Context

The insular view of mandatory appendectomy for appendicitis derives from the guidelines developed and advocated over 120 years ago by McBurney, and propagated from the erroneous belief that acute appendicitis is a progressive disease that always leads to perforation. In the bygone era before antibiotics, appendectomy saved lives. However, today with powerful antibiotics and a better understanding of the pathophysiological process of appendicitis, investigators are challenging these guidelines.

Interestingly, the history of the evolution of treatment for diverticulitis, which has a similar disease physiology, followed a different pathway compared with appendicitis. Colectomy, unlike appendectomy, in the 1900s was associated with high mortality and morbidity and so antibiotic treatment was adopted. Today, the primary …