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Incidental appendectomy? Microscopy tells another story: A retrospective cohort study in patients presenting acute

Dario Tartaglia1, Andrea Bertolucci1, Christian Galatioto1

  • 1Emergency Surgery Unit, University of Pisa, Pisa, Italy.

International Journal of Surgery (London, England)
|March 3, 2016
PubMed
Abstract

Insights

Appendectomy is recommended for patients undergoing laparoscopy for acute abdominal pain, even if the appendix appears normal. Microscopic examination reveals significant pathological changes in a majority of appendices, including inflammation and rare tumors.

Area of Science:

  • Laparoscopic surgery
  • Gastrointestinal pathology
  • Surgical decision-making

Background:

  • Management of a macroscopically normal appendix during laparoscopy for acute abdominal pain remains controversial.
  • Uncertainty exists regarding the optimal surgical approach when the appendix appears healthy upon visual inspection during laparoscopic procedures.

Purpose of the Study:

  • To evaluate the necessity and outcomes of incidental appendectomy in patients with acute abdominal pain and a visually normal appendix.
  • To determine the prevalence of microscopic pathological changes in appendices deemed normal during laparoscopy.

Main Methods:

  • A retrospective review of 164 patients undergoing laparoscopy for acute abdominal pain with a normal-appearing appendix.
  • Patients were divided into two groups: Group 1 (no other intra-peritoneal disease) and Group 2 (other intra-peritoneal conditions).
  • All patients underwent incidental appendectomy with subsequent histopathological examination of the specimen.

Main Results:

  • Microscopic examination revealed significant pathological changes in 76% of appendectomy specimens (125/164).
  • Inflammation was the most common finding (122 cases), with three cases of neuroendocrine tumors.
  • Pathological changes were more frequent in Group 1 (90%) compared to Group 2 (70%).
  • The morbidity rate associated with incidental appendectomy was 2%.

Conclusions:

  • Incidental appendectomy is supported in patients undergoing laparoscopy for acute right lower quadrant pain, even when the appendix appears normal visually.
  • Histopathological analysis frequently identifies underlying pathology missed during gross inspection.
  • This approach may prevent future complications and aid in accurate diagnosis.
Keywords:
Abdominal painAppendicitisLaparoscopic appendectomyNormal appendix

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