The morbidity of negative appendicectomy

Abstract

INTRODUCTION The increased use of diagnostic laparoscopy for management of right iliac fossa pain may have lowered the threshold for removing normal appendices, particularly as there is a perception that this practice carries little additional morbidity. The aim of this retrospective audit was to determine the negative appendicectomy rate after laparoscopic appendicectomy (LA) in our busy district hospital, and to compare the relative incidence and severity of complications after removal of an inflamed or non-inflamed appendix. METHODS Adult patients who underwent LA in 2011-2012 were identified from theatre registers. Histology results were reviewed to differentiate between inflamed and normal appendices. Postoperative complications and events following discharge were identified via electronic patient records. Complication severity was stratified using the Clavien-Dindo classification. RESULTS Over 2 years, 467 LAs were performed, of which 143 (30.6%) were for normal appendices. Significantly more negative appendicectomies were performed in women (43%) than in men (17%) (p<0.0001). Complications were seen in 62 patients (13.3%). There was no significant difference between the complication rates for those who had an inflamed (16.6%) or non-inflamed (11.9%) appendix (p=0.141). Similarly, there was no difference in the severity of complications between these groups. Reoperation or invasive intervention was required after four negative appendicectomies (2.8%). CONCLUSIONS LA carries a similar morbidity regardless of whether the appendix is inflamed. Negative appendicectomy should not be undertaken routinely during laparoscopy for right iliac fossa pain.

Acute appendicitis

“…[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.…”

“…[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Abdominal pain is the most common feature. 5 Movement such as coughing and driving over uneven roads can exacerbate the pain of localised peritonism.…”

“…5 Movement such as coughing and driving over uneven roads can exacerbate the pain of localised peritonism. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Patients may also give a history of feeling generally unwell, weak, cold, and clammy, or describe any symptom in keeping with sepsis. 5 A meta-analysis of clinical presentations in appendicitis showed that migratory pain was the strongest symptom associated with a diagnosis of acute appendicitis.…”

“…[16][17][18] In practice, the decision is based on the following considerations for the individual patient:…”

Appendicitis in a deployed military setting: diagnosis, management and impact on the fighting force

“…The way a NA is defined also has an influence on the NA rate. In a diagnostic era where diagnostic laparoscopy is increasingly common and debate continues as to whether the removal of a macroscopically normal appendix is justified,11 12 sufficient clinical grounds to operate no longer mandates an appendicectomy. Hence, appendicitis may be a clinical, radiological, operative or histological diagnosis with the latter being regarded as the gold standard in confirmation of appendicitis.…”