Laparoscopic Appendectomy does not Increase the Rate of Negative Appendectomy along with a Lower Rate of Perforated Appendicitis – Results in 1899 Patients at Zagreb UHC

Abstract

SUMMARY – Laparoscopic appendectomy is the method of choice of many professional societies owing to its many advantages. The question arises whether surgeons urge more easily to laparoscopic exploration due to its less invasiveness, faster recovery and adequate exploration of the entire abdominal cavity than to observation in unequivocal cases. This retrospective analysis (2009-2016) included 1899 patients undergoing laparoscopic (lap) or gridiron intra-abdominal approach treated at Zagreb University Hospital Centre. The analysis included total negative appendectomy, negative-negative appendectomy (normal appendix and no other pathology found), and negative-positive appendectomy (normal appendix but another pathology found) in children (≤16 years) and adults. There was no statistically significant difference in the rates of negative appendectomy (children) – lap vs . open (p=0.24); negative appendectomy (adults) – lap vs . open (p=0.15); negative-negative appendectomy (children) – lap vs . open (p=0.36); negative-negative appendectomy (adults) – lap vs . open (p=0.21); negative-positive appendectomy (children) – lap vs . open (p=0.53); negative-positive appendectomy (adults) – lap vs . open (p=0.56); and laparoscopy group negative appendectomy in children vs . adults (p=0.56). There was a statistically significantly higher perforation rate with the open approach in total (p<0.0001), in children (p<0.0001) and in adults (p=0.02). There was no statistically significant difference between adults and children in the perforation rate with laparoscopic approach (p=0.24) and perforation rate with open approach (p=0.29). Results confirmed that there was no statistically significant difference in the rate of negative appendectomy in all subgroups. It is concluded that laparoscopic appendectomy should be offered as the method of choice in any patient population with suspicion of acute appendicitis.

Trends and Predictors of Pediatric Negative Appendectomy Rates: A Single-Centre Retrospective Study

“…The criteria for calculating the incidence of negative appendectomies are described in detail in this study. Our results of the overall incidence are comparable and similar to the results of studies published so far on the incidence of negative appendectomies in children and adults [28,29,31]. Some authors doubted whether the laparoscopic approach increases the number of negative appendectomies.…”

“…Some authors doubted whether the laparoscopic approach increases the number of negative appendectomies. A recent study clearly showed that laparoscopic appendectomy should be offered as the method of choice in any patient population with suspicion of acute appendicitis and that the laparoscopic approach does not increase the number of negative appendectomies [31].…”

Validity of Appendicitis Inflammatory Response Score in Distinguishing Perforated from Non-Perforated Appendicitis in Children

“…Despite advances in medicine, acute appendicitis is still a diagnostic problem and a challenge for even experienced emergency physicians and pediatric surgeons. The latter is demonstrated by the high negative appendectomy rates, ranging between 10% and 20%, documented in the literature [ 6 , 7 , 8 , 9 ]. The aforementioned negative appendectomy rate can be significantly lowered to 2.7% with the routine use of imaging [ 10 ].…”

Other Pathologies Were Rarely Reported after Laparoscopic Surgery for Suspected Appendicitis: A Systematic Review and Meta-Analysis

“…An overview of malignant findings can be seen in Table 2. Only 5 studies [18, 31, 36, 38, 42] did not mention malignancy, while all other studies had at least two categories such as “malignancy” and “other findings.” Meta-analysis showed that patients operated for suspected acute appendicitis had an estimated rate of malignancy of 1% (95% CI 0.8–1.3) (Fig. 3).…”