INTRODUCTION: The increased use of diagnostic laparoscopy for management of right iliac fossa pain may have lowered the threshold for removing normal appendices, particularly as there is a perception that this practice carries little additional morbidity. The aim of this retrospective audit was to determine the negative appendicectomy rate after laparoscopic appendicectomy (LA) in our busy district hospital, and to compare the relative incidence and severity of complications after removal of an inflamed or non-inflamed appendix. METHODS: Adult patients who underwent LA in 2011-2012 were identified from theatre registers. Histology results were reviewed to differentiate between inflamed and normal appendices. Postoperative complications and events following discharge were identified via electronic patient records. Complication severity was stratified using the Clavien-Dindo classification. RESULTS: Over 2 years, 467 LAs were performed, of which 143 (30.6%) were for normal appendices. Significantly more negative appendicectomies were performed in women (43%) than in men (17%) (p<0.0001). Complications were seen in 62 patients (13.3%). There was no significant difference between the complication rates for those who had an inflamed (16.6%) or non-inflamed (11.9%) appendix (p=0.141). Similarly, there was no difference in the severity of complications between these groups. Reoperation or invasive intervention was required after four negative appendicectomies (2.8%). CONCLUSIONS: LA carries a similar morbidity regardless of whether the appendix is inflamed. Negative appendicectomy should not be undertaken routinely during laparoscopy for right iliac fossa pain.
INTRODUCTION: The increased use of diagnostic laparoscopy for management of right iliac fossa pain may have lowered the threshold for removing normal appendices, particularly as there is a perception that this practice carries little additional morbidity. The aim of this retrospective audit was to determine the negative appendicectomy rate after laparoscopic appendicectomy (LA) in our busy district hospital, and to compare the relative incidence and severity of complications after removal of an inflamed or non-inflamed appendix. METHODS: Adult patients who underwent LA in 2011-2012 were identified from theatre registers. Histology results were reviewed to differentiate between inflamed and normal appendices. Postoperative complications and events following discharge were identified via electronic patient records. Complication severity was stratified using the Clavien-Dindo classification. RESULTS: Over 2 years, 467 LAs were performed, of which 143 (30.6%) were for normal appendices. Significantly more negative appendicectomies were performed in women (43%) than in men (17%) (p<0.0001). Complications were seen in 62 patients (13.3%). There was no significant difference between the complication rates for those who had an inflamed (16.6%) or non-inflamed (11.9%) appendix (p=0.141). Similarly, there was no difference in the severity of complications between these groups. Reoperation or invasive intervention was required after four negative appendicectomies (2.8%). CONCLUSIONS: LA carries a similar morbidity regardless of whether the appendix is inflamed. Negative appendicectomy should not be undertaken routinely during laparoscopy for right iliac fossa pain.
Authors: Dirk H S M Schellekens; Karel W E Hulsewé; Bernadette A C van Acker; Annemarie A van Bijnen; Tom M H de Jaegere; Suprapto H Sastrowijoto; Wim A Buurman; Joep P M Derikx Journal: Acad Emerg Med Date: 2013-07 Impact factor: 3.451
Authors: Jenneke T H Hamminga; H Sijbrand Hofker; Paul M A Broens; Philip M Kluin; Erik Heineman; Jan Willem Haveman Journal: Surg Endosc Date: 2012-10-17 Impact factor: 4.584
Authors: M-O Sauvain; K Slankamenac; M K Muller; S Wildi; U Metzger; W Schmid; J Wydler; P-A Clavien; D Hahnloser Journal: Langenbecks Arch Surg Date: 2016-05-04 Impact factor: 3.445
Authors: Salomone Di Saverio; Arianna Birindelli; Micheal D Kelly; Fausto Catena; Dieter G Weber; Massimo Sartelli; Michael Sugrue; Mark De Moya; Carlos Augusto Gomes; Aneel Bhangu; Ferdinando Agresta; Ernest E Moore; Kjetil Soreide; Ewen Griffiths; Steve De Castro; Jeffry Kashuk; Yoram Kluger; Ari Leppaniemi; Luca Ansaloni; Manne Andersson; Federico Coccolini; Raul Coimbra; Kurinchi S Gurusamy; Fabio Cesare Campanile; Walter Biffl; Osvaldo Chiara; Fred Moore; Andrew B Peitzman; Gustavo P Fraga; David Costa; Ronald V Maier; Sandro Rizoli; Zsolt J Balogh; Cino Bendinelli; Roberto Cirocchi; Valeria Tonini; Alice Piccinini; Gregorio Tugnoli; Elio Jovine; Roberto Persiani; Antonio Biondi; Thomas Scalea; Philip Stahel; Rao Ivatury; George Velmahos; Roland Andersson Journal: World J Emerg Surg Date: 2016-07-18 Impact factor: 5.469