On-table diagnostic accuracy and the clinical significance of routine exploration in open appendectomies

The current practice of further exploration for other intra-abdominal pathology only when a normal appendix is found may leave other organic causes of acute abdomen undetected if the surgeon's on-table diagnostic accuracy is low.

In this retrospective study in 518 patients who underwent surgery for acute appendicitis, the on-table operative diagnosis of surgeons was correlated with the histological diagnosis of pathologists.

Surgeons were unable to make an accurate on-table diagnosis in 14.3% of cases. The sensitivity for diagnosing normal appendices was also low at 51.3%, suggesting that almost half of normal appendices were misdiagnosed as acute appendicitis and there was no further exploration for other pathology. It was also found that surgeon's experience, patient gender and patient age had no significant effect on diagnostic accuracy.

Based on these results, it seems that the on-table diagnostic accuracy in open appendectomies is low and surgeons' on-table diagnosis should not be the determining factor for whether further exploration is necessary. Exploration for other intra-abdominal pathology should be routine irrespective of the on-table diagnosis, the surgeon's experience and patient gender and age. An alternative is minimal-access surgery in which inspection of other intra-abdominal organs can be performed more easily.