Laparoscopy for Suspected Appendicitis in Children: May a Macroscopically Normal Appendix be Left In Situ?

Dingemann, Jens; Metzelder, Martin L.; Jf, Kuebler; B, Ure

doi:10.1055/s-0029-1202248

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…Twenty one patients had macroscopically normal appendices left insitu. Over a mean follow‐up period of 25 months, 18 patients (86%) had minimal medical attention (0–2 visits), while 3 patients had 2 or more consultations for abdominal symptoms; however, no patient underwent an operation for acute appendicitis [12]. In comparison to our study, there were 19 paediatric patients that underwent an initial exploratory laparoscopy for RIF pain which found macroscopically normal appendices.…”

Section: Discussionmentioning

confidence: 61%

“…Twenty one patients had macroscopically normal appendices left insitu. Over a mean follow-up period of 25 months, 18 patients (86%) had minimal medical attention (0-2 visits), while 3 patients had 2 or more consultations for abdominal symptoms; however, no patient underwent an operation for acute appendicitis [12]. In Table 2 Demographic characteristics and intra-operative findings at index laparoscopy of patients who underwent a repeat laparoscopy and subsequent appendicectomy vs those who did not have an appendicectomy during the follow-up period (n =120) comparison to our study, there were 19 paediatric patients that underwent an initial exploratory laparoscopy for RIF pain which found macroscopically normal appendices.…”

Section: Discussionmentioning

confidence: 99%

“…There are multiple studies that recommend leaving a macroscopically normal appendix in situ during laparoscopy [10][11][12][13]. Negative appendectomy rates are high worldwide, ranging from 10 to 30% across multiple studies [5,6,14,15].…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of the Macroscopically Normal Appendix Left in Situ in Patients with Suspected Appendicitis

et al. 2022

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Background Right iliac fossa (RIF) pain is a common indication for laparoscopy to diagnose and treat appendicitis. When a macroscopically normal appendix is found, there is no standard consensus regarding excision. Some surgeons remove the appendix due to the risk of microscopic inflammation and to avoid a future, repeat laparoscopy for possible appendicitis. Alternatively, others leave the appendix in situ to avoid morbidity from a potentially unnecessary procedure. We aimed to evaluate the outcomes of patients with macroscopically normal appendices left in situ. Methods All emergency laparoscopies without appendicectomy between January 1st 2010-December 31st 2020 were identified from theatre records. All operative notes were individually evaluated and comments on the macroscopic appearance of the appendix and any intra-operative pathology were recorded. Only patients undergoing laparoscopy for suspected appendicitis with macroscopically normal appendices were included. Results A total of 120 patients [median age 21.68 (range 9-90.8) years] were included. The cohort was predominantly female (n=105, 87.5%). Forty-eight patients (40.0%) had a positive finding during index laparoscopy. During a median duration of 94.5 (range 8-131) months' follow-up, 16 patients (13.33%) underwent a repeat laparoscopy for recurrent RIF pain. Thirteen (10.8% of total cohort) subsequently underwent an appendicectomy. Histology confirmed acute appendicitis in six cases (4.17% of entire cohort). On subanalysis of smaller cohort, index laparoscopies with no positive findings (n=72), nine patients (12.5%) underwent appendicectomy with two (2.7%) appendices demonstrating appendicitis on histological examination. Conclusion 87% of the total cohort with a normal appendix at laparoscopy for RIF pain did not undergo further laparoscopy. Less than 5% of the total cohort and 2.7% of subanalysis cohort had an appendicectomy for histologically-proven appendicitis within the follow-up period. From the evidence in this study, we conclude that leaving the appendix in situ unless macroscopically inflamed is a viable alternative to excision.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

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Outcomes of the Macroscopically Normal Appendix Left in Situ in Patients with Suspected Appendicitis

et al. 2022

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“…Other advantages include less pain, shortened hospital stay, earlier return to normal activity, sport and work, and a reduced risk of a ‘negative’ appendicectomy – especially in fertile women [1]. It has been documented that a normal‐looking appendix may safely be left in situ in LA [3]. There is disagreement as to whether LA takes longer than OA and causes shorter duration of postoperative ileus.…”

mentioning

confidence: 99%

Open or laparoscopic appendicectomy?

Jørgensen

Wille‐Jørgensen

2009

Colorectal Disease

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Negative Appendectomy Rate and Implications of Removing a Normal Appendix

Broeck

2011

Imaging of Acute Appendicitis in Adults and Children

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Laparoscopy for Suspected Appendicitis in Children: May a Macroscopically Normal Appendix be Left In Situ?

Abstract: According to our results, a macroscopically inconspicuous appendix may be left in situ in patients undergoing laparoscopy for suspected appendicitis. However, this conclusion is based on a small number of patients and larger series are mandatory.

Cited by 5 publications

References 20 publications

Outcomes of the Macroscopically Normal Appendix Left in Situ in Patients with Suspected Appendicitis

Outcomes of the Macroscopically Normal Appendix Left in Situ in Patients with Suspected Appendicitis

Open or laparoscopic appendicectomy?

Negative Appendectomy Rate and Implications of Removing a Normal Appendix

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