Selective microscopic examination of gallbladders, hernia sacs, and appendices

The usefulness of many "routine" medical procedures is being challenged in the health care atmosphere of today. This study was undertaken to determine the utility of routine microscopic pathologic examination of three frequently submitted surgical specimens. Pathology reports of 39,568 consecutive specimens, 17,105 appendices, 14,654 hernia sacs, and 7,809 gallbladders, submitted over a 49-year period, were reviewed. Microscopic examination of these tissues detected few unexpected findings. In those instances in which unexpected findings were discovered the primary surgery was curative or additional surgery would not have altered the prognosis. When careful, thorough gross examination by the surgeon and pathologist failed to disclose significant abnormalities or confirmed obvious disease such as inflammation, microscopic examination of these tissues might have been eliminated without a change in patient outcome. Although it could be argued that this microscopic pathologic correlation may be helpful for quality control and/or feedback of surgical decision making, the data indicate that gross examination alone may be sufficient in most cases, since unexpected microscopic findings are rare. The indications for microscopic examination of appendices, hernia sacs, and gallbladders are listed. Substantial savings of resources and time may be expected when selective microscopic examination is used.