Unnecessary appendicectomy in suspected cases of acute appendicitis

Acute appendicitis is a common emergency encountered by general surgeons and is managed effectively by timely appendicectomy. Open appendicectomy is usually the first abdominal operation which a surgical resident learns during his training. In this study, 912 appendicectomies were performed on clinical suspicion of acute appendicitis during the period of 6 years (2003-2008) at Medical College, Kolkata and all the appendix specimens were sent for histopathological confirmation. The negative appendicectomy rate in this study was 36.40% which was significantly higher (p < 0.01) than other contemporary studies. Similarly, females had a higher number of negative appendicectomy at 40.34% as against 26.80% for males ( p < 0.001). Of the 409 specimens (44.85%) thought of "normal" appendix intra-operatively, 77 came out to be having acute appendicitis in histopathology report (intra-operative assessment sensitivity of 86.72% and negative predictive value of 81.17%). So even though there is increased morbidity and mortality if acute appendicitis is not diagnosed early, there is always a tendency among surgeons for over diagnosis and adding to the cost of already burdened government healthcare centres in developing countries. A thorough work-up with pre-operative imaging and diagnostic laparoscopy where applicable is advised for appendicectomy before subjecting a patient presenting with right iliac fossa pain.