Management of the Normal Appendix during Laparoscopy for Right Iliac Fossa Pain

Turner, Emma; Lightwood, Robin G.; Mishra, RK

doi:10.5005/jp-journals-10007-1018

Cited by 8 publications

(7 citation statements)

References 14 publications

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“…Our survey found that the majority of surgeons would remove a macroscopically normal appendix, which supports the practice of British and Irish surgeons where 61% would perform an appendicectomy. 2 The most common reason given for removing the appendix was ‘for possible endoluminal appendicitis’. This has clear evidence behind it, with Phillips et al finding almost a third of apparently normal appendices being inflamed histologically.…”

Section: Discussionmentioning

confidence: 99%

“…A 2009 study of members of the Association of Laparoscopic Surgeons of Great Britain and Ireland found that 61% would remove a ‘normal’ appendix and that 68% felt that guidance was needed. 2 We sought to expand this survey of opinion by asking about the practices of members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the French Society for Endoscopic Surgery (SFCE) and the Italian Society for Endoscopic Surgery (SICE).…”

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confidence: 99%

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An international survey of opinion regarding investigation of possible appendicitis and laparoscopic management of a macroscopically normal appendix

Jaunoo

Hale

Masters

et al. 2012

annals

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INTRODUCTIONThe use of imaging and laparoscopy in patients with right iliac fossa pain as tools to make or exclude a diagnosis of appendicitis is at the discretion of the clinician. We sought to establish a consensus of opinion on this matter by surveying professional bodies for laparoscopic surgery in France, Italy and the US.METHODSA survey was sent to members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), as well as the French Society for Endoscopic Surgery (SFCE) and the Italian Society for Endoscopic Surgery (SICE). The survey asked about management of both male and female patients presenting with right iliac fossa pain and what operative strategy the respondents would pursue should they find a macroscopically normal appendix at laparoscopy.RESULTSA total of 364 responses were returned from the three groups. The responses from SAGES showed computed tomography to be the preferred modality for investigating patients with right iliac fossa pain, irrespective of sex. Both SFCE and SICE preferred the use of diagnostic laparoscopy, especially in the female patient group. The majority of all respondents stated that they would remove a macroscopically normal appendix at laparoscopy.CONCLUSIONSLaparoscopy remains a potent tool in the management of appendicitis. However, the dilemma of when to remove a macroscopically normal appendix remains. Our study shows that removal of the appendix in this instance would be supported by an international consensus.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

An international survey of opinion regarding investigation of possible appendicitis and laparoscopic management of a macroscopically normal appendix

Jaunoo

Hale

Masters

et al. 2012

annals

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“…Jane E. et al, gave an explanation for that the appendix in some patients with colonic diverticulitis, colitis, or pelvic inflammatory disease had a secondary edema or serosal inflammation. (28) There was one case of carcinoid tumor presented as acute appendicitis, it was evident as yellowish small oval mass (8mm x 4mm) in the base of the appendix, this presentation is not going in line with literature. Studies were reporting that carcinoid tumors were not evident macroscopically.…”

Section: Discussionmentioning

confidence: 87%

“…(2,12,13,32,33) Also it needs ionizing radiation; it is not routinely available at all hours and has false negative results as high as 15%. (3,4,7,(11)(12)(13)28) The effect of ionizing radiation may be a drawback especially the patients with uncertain clinical diagnosis, who need a CT usually are adolescence or young child bearing ladies (2,12,13,18,19,28) .…”

Section: The Limitations Of the Workmentioning

confidence: 99%

Alternative diagnosis for pain in patients who underwent appendectomies for normal appendices and the incidence of negative appendectomies

Ahmed¹,

Muhammed²

2011

Ann Coll Med Mosul

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Background and objectives: Some gastrointestinal and genitourinary tract pathologies can simulate clinical features of acute appendicitis; we aim to determine the alternative diagnosis for the pain in which appendicitis was considered, and to find the incidence of negative appendectomies in our practice. Methods: An observational study, including 558 patients, who underwent an appendectomy at Al Sulaimaniyah Teaching Hospital (STH) from the 2 nd of January to the 30 th of June 2009. Only patients who underwent urgent appendectomy and the specimen subjected to tissue examination were included. Appendices were labeled acutely inflamed when, macroscopically there were injections of mucosa, fibrinous or purulent film, edematous or necrotic changes of the wall and blood or pus on opening the appendix. Results: Most of the patients were young between 20-40 years age with median age of 22 ±7.7 years. Other pathologies presented in patients with macroscopically normal appendices, included 35 (6.27%) patients had purulent peritoneal fluids occured in young female with tubo-ovarian infections, 12 (2.15%) patients had mesenteric lymphadenitis and 37 (6.63%) patients had rupture Graafian follicles. Histologically normal appendix was present in 178 (31.89 %) patients, 61 (10.93%) of them were males and 117 (20.96%) were females. Conclusion: Normal appendectomies were found in 32 % of the patients, more frequently in young female patients, undergoing early (within 6 hrs since the pain) appendectomy, with the most common alternative diagnosis of tubo-ovarian infections.

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“…Cases of symptoms requiring reoperation for appendectomy have been described in patients whose normal appendix was left in place at the time of the original procedure (as in our case) [ 4 ]. Even in lack of evidence, gynecologists seem to be largely geared towards removing the appendix during surgery for other gynecological pathologies although this appears to be normal [ 9 , 10 ]; furthermore, intraoperative diagnosis is not easy, with almost one-third of apparently normal appendices being inflamed histologically [ 6 , 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Appendectomy during Laparoscopic Surgery for Other Conditions

Occhionorelli

Stano

Targa

et al. 2014

Case Reports in Medicine

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Acute appendicitis remains the most common surgical emergency. Laparoscopy has gained increasing favor as a method of both investigating right iliac fossa pain and treating the finding of appendicitis. A question arises: what to do with an apparent healthy appendix discovered during laparoscopic surgery for other pathology. We present a case of unilateral hydroureteronephrosis complicated with rupture of the renal pelvis, due to gangrenous appendicitis with abscess of the right iliopsoas muscle and periappendicular inflammation in a 67-year-old woman, who underwent laparoscopic right annessiectomy for right ovarian cyst few years earlier, in which a healthy appendix was left inside. There is a lack of consensus in the literature about what to do with a normal appendix. The main argument for removing an apparently normal appendix is that endoluminal appendicitis may not be recognized during surgery, leading to concern that an abnormal appendix is left in place. Because of a lack of evidence from randomized trials, it remains unclear whether the benefits of routine elective coincidental appendectomy outweigh the costs and risks of morbidity associated with this prophylactic procedure. Nevertheless, it appears, from limited data, that women aged 35 years and under benefit most from elective coincidental appendectomy.

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Management of the Normal Appendix during Laparoscopy for Right Iliac Fossa Pain

Cited by 8 publications

References 14 publications

An international survey of opinion regarding investigation of possible appendicitis and laparoscopic management of a macroscopically normal appendix

An international survey of opinion regarding investigation of possible appendicitis and laparoscopic management of a macroscopically normal appendix

Alternative diagnosis for pain in patients who underwent appendectomies for normal appendices and the incidence of negative appendectomies

Prophylactic Appendectomy during Laparoscopic Surgery for Other Conditions

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