Comparison of clinical and histopathological features of patients who underwent incidental or emergency appendectomy

Abstract

BACKGROUNDIncidental appendectomy can be defined as the removal of a clinically normal appendix during another surgical procedure unrelated to appendicitis or other appendicular diseases.AIMTo compare the demographic, biochemical, and histopathological features of the patients who underwent incidental and standard appendectomy.METHODSThe demographic, biochemical, and histopathological data of 72 patients (Incidental App group) who underwent incidental appendectomy during living donor hepatectomy at our Liver Transplant Center between June 2009 and December 2016 were compared with data of 288 patients (Acute App group) who underwent appendectomy for presumed acute appendicitis. The Incidental App group was matched at random in a 1:4 ratio with the Acute App group in the same time frame. Appendectomy specimens of both groups were re-evaluated by two experienced pathologists.RESULTSStatistically significant differences were found between groups in terms of age (P = 0.044), white blood cell count (P < 0.001), neutrophil (P < 0.001), lymphocyte (P < 0.001), red cell distribution width (P = 0.036), mean corpuscular hemoglobin (P = 0.001), bilirubin (P = 0.002), appendix width (P < 0.001), and presence of acute appendicitis histopathologically (P < 0.001). However, no statistically significant differences were found between groups in terms of gender, platelet, mean platelet volume, mean corpuscular volume, platelet distribution width, appendix length. While the most common histopathological findings in the Incidental App group were normal appendix vermiformis (72.2%), fibrous obliteration (9.7%) and acute appendicitis (6.9%), the most common histopathological findings in the Acute App group were non-perforated acute appendicitis (62.8%), perforated appendicitis (16.7%), lymphoid hyperplasia (8.3%), and appendix vermiformis (6.3%).CONCLUSIONCareful inspection of the entire abdominal cavity is useful for patients undergoing major abdominal surgery such as donor hepatectomy. We think that experience is parallel to the surgeon’s foresight, and we should not hesitate to perform incidental appendectomy when necessary

Evaluation of Liver Transplant Recipients Underwent Incidental Appendectomies

“…An incidental appendectomy is defined as the resection of the vermiform appendix during an abdominopelvic surgery that was originally indicated for reasons other than appendiceal diseases. Since the term “incidental appendectomy” was originally defined by Kell in 1902, many controversies have arisen regarding which patients should undergo the procedure [ 8 , 9 , 13 ]. Naturally, gynecologists, surgeons, and urologists publish the majority of studies describing incidental appendectomies.…”

“…Furthermore, regardless of the appendicitis risk, they emphasize that during appendectomies for appendicitis, the complication risk and operative time both increase due to the formation of adhesions following major operations. They further recommend appendectomies during major abdominopelvic operations whenever feasible [ 2 , 8 ]. Additionally, tumors can be found in the incidental appendectomy specimens, providing another reason for performing incidental appendectomies [ 1 , 8 , 9 ].…”

“…Between September 2002 and July 2019, 2500 patients underwent LT at our Liver Transplantation Institute, including 38 (24 males, 14 females) who also underwent incidental appendectomies during LT or during re-laparotomy in the early postoperative period. The following criteria, recognized by international associations, were used to determine the appropriateness of incidental appendectomy: (i) increased risk of appendicitis after major abdominal surgery, such as LT; (ii) the risk of complications and the duration of surgery may increase when the appendectomy is performed in patients with histories of major abdominal surgeries; (iii) the lateral end of the J incision used for recipient hepatectomy is very close to the ileocecal region and, therefore, increases the risk of manipulation of the vermiform appendix during abdominal wall retraction; (iv) palpable fecaliths within the vermiform appendix; and (v) intraoperative findings suggestive of acute appendicitis, including a vermiform appendix that is increased in size, demonstrating wall edema or hyperemia, and is erect [ 8 , 9 ]. Experienced gastrointestinal surgeons made the decisions to perform incidental appendectomies.…”

“…Further, lymphoid hyperplasia and appendiceal lumen obstruction by fecaliths are the two most frequent etiologies of acute appendicitis in children and adults, respectively [ 3 , 4 ]. In males, the lifetime risk of acute appendicitis is 8.6%; in females, the risk is 6.9% [ 5 – 8 ]. However, epidemiology studies have shown that the risk of undergoing an appendectomy, at any stage of life, is 12–23% [ 7 – 9 ].…”

Unusual infectious agents detected in appendectomy specimens: A retrospective analysis of 42 cases

“…The pathogenesis of AAp is believed to reflect an initial insult to the mucosa, resulting from luminal obstruction, followed by bacterial infection that progressively spreads from the mucosa into the wall of the appendix. It has been previously shown that multiple parasitic diseases can cause AAp in many parts of the world, in particular in underdeveloped countries due to socio-cultural issues and poor hygienic conditions (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). The ability of parasites to cause AAp has been debated in the past (3,4,11).…”