The Unacceptable Morbidity of Negative Laparoscopic Appendicectomy

Abstract

The morbidity of negative LA is the same as LA for uncomplicated appendicitis. The morbidity of LA for complicated appendicitis is significantly higher. The selection criteria for LA in our unit needs to be reviewed to address the high negative appendicectomy rate and avoid unnecessary surgery and its associated morbidity.

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

“…The authors reported an overall negative appendectomy rate of 36.0% among 1413 patients who met inclusion criteria (904 in the positive group and 509 in the negative group). Morbidity rates (6.3% vs 6.9%; P = 0.48) and types of morbidity were the same for negative appendicectomy and uncomplicated AA, and there was no significant difference in complication severity or length of stay (2.3 vs 2.6 days; P = 0.06) between negative appendicectomy and uncomplicated AA groups [200].…”

Non‐operative management of small post‐appendicectomy intra‐abdominal abscess is safe and effective

“…Detailed analysis of the indications, findings and outcomes have been previously published. 8 There were 42 (0.9%) patients with post-appendicectomy IAA that comprised this cases series. Sixteen (38.1%) had large (> 4 cm) IAAs that were managed with a percutaneous drainage.…”

“…1,[4][5][6]35,36 One explanation is the high negative appendicectomy rate (36%) during the study period. 8 As IAA is more commonly associated with complicated appendicitis compared with uncomplicated appendicitis [4][5][6] but has a similar incidence for uncomplicated appendicitis and a normal appendix, 8 this is less likely to be the sole explanation. Another explanation is the use of laparoscopic washout in 41 (0.8%) patients with persistent evidence of sepsis following appendicectomy during the study period 37 that may have resulted in the prevention of the subsequent development of an IAA.…”

“…Patients with post-appendicectomy IAA were identified as part of a large cases series study on the outcomes of appendicectomy. 8,30,31 Prior to commencement of the study, ethics approval was obtained from the Nepean Blue Mountains Local Health District Human Research Ethics Committee (study numbers 14/29 and 14/67). Only patients with suspected acute appendicitis were included; appendicectomies performed for other indications were excluded.…”

“…Post-operative intra-abdominal abscess (IAA) is a serious complication of appendicectomy with an incidence ranging from 1.4% to 4.4%. [1][2][3][4][5][6][7] The incidence is significantly higher in complicated (gangrenous or perforated) appendicitis compared with uncomplicated appendicitis [3][4][5]8,9 and when there is more extensive peritoneal contamination. 10,11 Early in the laparoscopic era, there was an increased incidence of IAA following laparoscopic appendicectomy (LA) for complicated appendicitis compared to open surgery.…”