Tian J. Appendicolith in non-operative management of acute appendicitis: Implications for recurrence and future directions. World J Clin Cases 2025; 13(28): 109664 [DOI: 10.12998/wjcc.v13.i28.109664]
Corresponding Author of This Article
Ju Tian, Department of Burns and Plastic Surgery, Zhongshan City People’s Hospital, No. 2 Sunwen East Road, Zhongshan 528400, Guangdong Province, China. tian-ju@163.com
Research Domain of This Article
Surgery
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Appendicolith in non-operative management of acute appendicitis: Implications for recurrence and future directions
Ju Tian
Ju Tian, Department of Burns and Plastic Surgery, Zhongshan City People’s Hospital, Zhongshan 528400, Guangdong Province, China
Author contributions: Tian J conceptualized and designed the overarching framework and structure of the manuscript. In addition, Tian J actively participated in drafting and revising the content, creating the illustrations, and conducting a comprehensive review of the pertinent literature.
Conflict-of-interest statement: Dr. Tian has nothing to disclose for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ju Tian, Department of Burns and Plastic Surgery, Zhongshan City People’s Hospital, No. 2 Sunwen East Road, Zhongshan 528400, Guangdong Province, China. tian-ju@163.com
Received: May 18, 2025 Revised: June 4, 2025 Accepted: July 17, 2025 Published online: October 6, 2025 Processing time: 81 Days and 23.4 Hours
Abstract
Appendicoliths are frequently encountered in acute appendicitis (AA) and historically considered a risk factor for treatment failure in nonoperative management (NOM). However, the impact of appendicoliths on recurrence rates in uncomplicated AA remains controversial. This editorial critically appraises the study by Kupietzky et al, which explored the relationship between appendicolith characteristics and NOM outcomes. Kupietzky et al conducted a retrospective analysis of 797 patients with uncomplicated AA, comparing recurrence rates between those with and without appendicoliths. The study focused on long-term follow-up (median 44.2 months) and subgroup analyses of stone characteristics. The study revealed no significant difference in overall recurrence rates between groups (26.5% vs 19.1%, P = 0.14). However, patients with appendicoliths experienced earlier recurrence (3.9 months vs 5.9 months, P = 0.04) and had larger appendix diameters (10.2 mm vs 8.5 mm, P = 0.001). Subgroup analyses showed no correlation between stone size, location, or number and recurrence risk. Appendicoliths do not independently increase the overall recurrence risk after NOM for uncomplicated AA but may accelerate recurrence timelines. Clinical decisions should prioritize individualized risk assessment, considering patient age, symptom severity, and radiological features. These findings challenge traditional paradigms and advocate for shared decision-making between clinicians and patients.
Core Tip: Kupietzky et al’s study challenges traditional paradigms by demonstrating that appendicoliths alone do not independently elevate long-term recurrence risks in uncomplicated acute appendicitis, thereby reframing nonoperative management as a viable option for low-risk patients. Instead, clinical decisions should prioritize individualized risk assessments—incorporating symptom severity, imaging markers (e.g., appendix diameter > 1 cm), and shared decision-making with patients—while emphasizing close surveillance (especially within the initial 6-12 months) to enable timely intervention for recurrences.
