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The morbidity of negative appendicectomy
Annals of the Royal College of Surgeons of England
|September 24, 2014
Summary
Laparoscopic appendicectomy (LA) for right iliac fossa pain results in a high rate of normal appendix removal, particularly in women. Morbidity is similar for inflamed or normal appendices, suggesting negative appendicectomy should not be routine.
Area of Science:
- Surgical outcomes
- Gastrointestinal surgery
- Diagnostic laparoscopy
Background:
- Diagnostic laparoscopy for right iliac fossa pain may increase normal appendix removal.
- Perception of low morbidity associated with removing normal appendices.
- Need to audit negative appendicectomy rates and associated complications.
Purpose of the Study:
- Determine the negative appendicectomy rate after laparoscopic appendicectomy (LA).
- Compare incidence and severity of complications for inflamed vs. normal appendices.
- Evaluate the impact of negative appendicectomy on patient outcomes.
Main Methods:
- Retrospective audit of adult patients undergoing LA (2011-2012).
- Histology reviewed to classify appendices as inflamed or normal.
- Postoperative complications identified via electronic records and stratified by Clavien-Dindo classification.
Main Results:
- 467 LAs performed; 143 (30.6%) were negative appendicectomies.
- Significantly higher rate in women (43%) vs. men (17%) (p<0.0001).
- Overall complication rate 13.3%; no significant difference between inflamed (16.6%) and normal (11.9%) appendices.
Conclusions:
- Laparoscopic appendicectomy morbidity is similar whether the appendix is inflamed or not.
- Routine negative appendicectomy during laparoscopy for right iliac fossa pain is not recommended.
- Negative appendicectomy occurred in 2.8% of cases requiring reoperation or intervention.
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