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Macroscopic findings at appendicectomy are unreliable: implications for laparoscopy and malignant conditions of the

John K Roberts1, Masoud Behravesh, Janek Dmitrewski

  • 1Department of Surgery, Russells Hall Hospital, Dudley, West Midlands, UK. jkroberts@doctors.org.uk

International Journal of Surgical Pathology
|April 5, 2008
PubMed
Abstract

Insights

Surgeons often misdiagnose normal appendices during laparoscopic appendicectomy, missing inflammation and neoplastic lesions. Removing all appendices, even those appearing normal, is recommended for accurate diagnosis and patient safety.

Area of Science:

  • Gastroenterology
  • Surgical Pathology

Background:

  • Laparoscopic appendicectomy is common, but surgeons sometimes leave appendices that appear normal.
  • The accuracy of macroscopic assessment versus histological findings needs evaluation.

Purpose of the Study:

  • To correlate surgeons' macroscopic findings with pathologists' histological assessments of the appendix.
  • To evaluate the safety and accuracy of leaving macroscopically normal appendices in situ after appendicectomy.

Main Methods:

  • Retrospective review of operative cases and histological findings over a 3-year period.
  • Analysis of 876 surgical notes and corresponding pathological reports.

Main Results:

  • High agreement between surgeons and pathologists for severe appendiceal pathologies (perforation, abscess, gangrene).
  • Significant discordance for inflammation: 8.3% of histologically normal appendices were recorded as inflamed, and 33.1% of appendices deemed normal during surgery showed inflammation.
  • Low detection rate of neoplastic lesions (3 out of 16) during surgery.

Conclusions:

  • Surgeons exhibit poor accuracy in diagnosing normal appendices and detecting neoplastic lesions during laparoscopic appendicectomy.
  • Routine removal of all appendices, irrespective of macroscopic appearance, is advised during laparoscopy for acute abdominal pain to ensure accurate diagnosis.

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