Should the Macroscopically Normal Appendix be Removed During Laparoscopy for Acute Right Iliac Fossa Pain When No Other Explanatory Pathology is Found?

Phillips, Alexander W; Jones, Alun E.; Sargen, Kevin

doi:10.1097/sle.0b013e3181b71957

Cited by 69 publications

(44 citation statements)

References 22 publications

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“…When we compared the surgeons' evaluations with those of the pathologists, only a small number of patients had been given a different diagnosis by the surgeons. We are aware of previous reports showing that as many as one third false negative diagnoses were made during diagnostic laparoscopy [26], and 9.2 -35% normal appendices were removed, based on postoperative histological evaluation [27]. There has been no consensus regarding the pathologists' evaluation of the appendix and the grade of inflammation in the present study.…”

Section: Odds Ratiocontrasting

confidence: 40%

Untitled

2017

Int J Surg Res Pract

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Section: Odds Ratiocontrasting

confidence: 40%

Untitled

2017

Int J Surg Res Pract

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“…We assume that either these findings could have been part of a more generalized inflammatory process which was missed by the operating surgeon, or he may have been biased in reporting these findings once these findings were subtle or absent. In nearly 10 % of patients, appendectomy was performed even in the absence of the operative findings suggesting AA; however, this can be justified as it is known that the appendix may appear grossly normal even in AA [30].…”

Section: Discussionmentioning

confidence: 99%

Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized?

Joshi

Alam

et al. 2014

Indian J Surg

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Negative appendectomy remains a concern in current surgical practice. Data from the developing world is scarce. Data of appendectomies during the last 5 years were analyzed. Interval and incidental appendectomies were excluded. The demographic details, presenting complaints, clinical signs, and investigations performed were recorded in a predesigned proforma. The data were critically analyzed. Six hundred eighty-five appendectomies were performed during the period. One hundred eighty-five patients with a normal appendix were identified on histopathology. Sixty-seven patients with incidental or interval appendectomies were excluded. Thus, 118 patients had appendectomies performed erroneously. All these patients with presumed diagnosis of acute appendicitis were operated on by resident surgeons. Records of 17 patients could not be retrieved. The most common symptom was abdominal pain (100 %), and the commonest sign was right iliac fossa tenderness (93 %). Most of the patients underwent USG to supplement the diagnosis. CT scan and diagnostic laparoscopy were not performed. The negative appendectomy rate was 17.2 % (12.4 % in males; 33.3 % in females). The highest incidence of negative appendectomy was in females aged 11-20 years (66.7 %). The rate of negative appendectomy at our institute is comparable with the world statistics. More diligence is required in making the clinical diagnosis of acute appendicitis, especially in young females. The use of C-reactive protein and CT scan may decrease the negative appendectomy rate.

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“…[15][16][17][18] Individually, the patient history, examination, and laboratory findings are of poor predicative value, but in combination their diagnostic value is much greater. [19][20][21] The differential diagnoses are broadest in pre-menopausal women, as symptoms of acute appendicitis can be similar to the pain some women experience during normal menstruation, dysmenorrhoea, or ovulation and pathology such as ovarian torsion, ectopic pregnancy, and pelvic inflammatory disease.…”

Section: What Causes Appendicitis?mentioning

confidence: 99%