[Acute appendicitis : can surgery be avoided ?].

Acute appendicitis has traditionally been treated with appendectomy. Over the past decade, several randomized trials have proposed using antibiotics as an alternative in selected patients with uncomplicated acute appendicitis. Approximately 55 to 60 % of patients treated with antibiotics avoid surgery, but the risk of recurrence or complications, particularly abcess formation, remains significant. Careful patient selection with CT imaging is therefore essential to exclude complicated appendicitis or the presence of an appendicolith. Furthermore, nearly 1 % of patients undergoing appendectomy are found to have an appendiceal tumor, which may be diagnosed later. Antibiotic therapy requires close follow-up and clear patient information. In 2026, appendectomy remains the safest and most definitive treatment.