Prophylactic Appendectomy during Laparoscopic Surgery for Other Conditions

Abstract

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.

Should an appendicectomy be performed in the presence of a macroscopically healthy appendix, during laparoscopic exploration?

“…Some authors suggest performing an appendicectomy for macroscopically normal appendices during laparoscopic exploration for acute painful syndromes in the right iliac fossa, suggestive of acute appendicitis [3][4][5][6][7]. According to these authors, acute appendicitis may be in its initial phase, with lesions located intramurally while the appendix appears macroscopically healthy.…”

“…For the latter, a macroscopically healthy appendix should be left in place because this action could lead to considerable morbidity and mortality, particularly acute intestinal obstructions and infectious complications [3,5,[13][14][15][16][17][18][19].…”

Análisis histopatológico en apendicectomía profiláctica

“…Se puede dividir terminológicamente en cuatro grupos según el momento de aparición y la indicación de la cirugía: apendicectomía de urgencia, apendicectomía electiva, apendicectomía incidental y apendicectomía profiláctica 3,4 incidental se realiza secundariamente durante una intervención quirúrgica por otra causa, generalmente ginecológica 5,6 , donde inclusive es recomendada por el Colegio Americano de Obstetricia y Ginecología (ACOG) en ciertos casos 7 , o en otra patología pélvica [8][9][10][11] , donde se decide la remoción del apéndice de manera preventiva.…”

Carcinoid Tumor of the Cecal Appendix

“…Acute appendicitis is the most common surgical emergency performed by a general surgeon [ 1 ]. It is performed either as definitive management of acute appendicitis or performed prophylactically during an intra-abdominal surgical procedure for another reason [ 2 ]. It is estimated that approximately 280,000 appendectomies are performed annually in the United States [ 3 ].…”