Surg Gynecol Obstet. 1990 Jul;171(1):95-8.
Guidelines for therapeutic decision in incidental appendectomy.
Source
Department of Surgery, Southern Illinois University School of Medicine, Springfield 62794-9230.Abstract
Incidental appendectomy is contraindicated in patients whose conditions are unstable, patients previously diagnosed with Crohn's disease, patients with an inaccessible appendix, patients undergoing radiation treatment, patients who are pathologically or iatrogenically immunosuppressed and patients with vascular grafts or other foreign material. In patients ten to 30 years of age--the age group associated with a higher incidence of acute appendicitis--who are otherwise healthy, incidental appendectomy is effective in preventing morbidity and death associated with acute appendicitis. In patients 30 to 50 years of age, incidental appendectomy should be left to the discretion of the surgeon. In this age group, the physician should give special consideration to the gender of the patient and the desire for future childbirth. In patients more than 50 years of age, the incidence of acute appendicitis decreases and the risk associated with operation and prolonged anesthesia is such that an incidental appendectomy is not beneficial. In mentally handicapped patients less than 50 years of age and who are physically healthy, incidental appendectomy should be performed. An inversion technique should be used in all instances of incidental appendectomy. In otherwise clean cases in which incidental appendectomy is anticipated, prophylactic antibiotics may be of value. Patients undergoing procedures that may compromise access to the appendix in the future should undergo incidental appendectomy.Am J Surg. 2011 Apr;201(4):433-7.
Negative appendectomy: a 10-year review of a nationally representative sample.
Seetahal SA, Bolorunduro OB, Sookdeo TC, Oyetunji TA, Greene WR, Frederick W, Cornwell EE 3rd, Chang DC, Siram SM.
Source
Howard Hopkins Center for Outcomes Research, Department of Surgery, Howard University College of Medicine, Washington, DC 20060, USA. shiva_seetahal@yahoo.comAbstract
BACKGROUND:
Appendectomy remains one of the most common emergency surgical procedures encountered throughout the United States. With improvements in diagnostic techniques, the efficiency of diagnosis has increased over the years. However, the entity of negative appendectomies still poses a dilemma because these are associated with unnecessary risks and costs to both patients and institutions. This study was conducted to show current statistics and trends in negative appendectomy rates in the United States.METHODS:
A retrospective analysis was conducted using data from the National Inpatient Sample from 1998 to 2007. Adult patients (>18 y) having undergone appendectomies were identified by the appropriate International Classification of Diseases 9th revision codes. Patients with incidental appendectomy and those with appendiceal pathologies, also identified by relevant International Classification of Diseases 9th revision codes, were excluded. The remaining patients represent those who underwent an appendectomy without appendiceal disease. The patients then were stratified according to sex, women were classified further into younger (18-45 y) and older (>45 y) based on child-bearing age. The primary diagnoses subsequently were categorized by sex to identify the most common conditions mistaken for appendiceal disease in the 2 groups.RESULTS:
Between 1998 and 2007, there were 475,651 cases of appendectomy that were isolated. Of these, 56,252 were negative appendectomies (11.83%). There was a consistent decrease in the negative appendectomy rates from 14.7% in 1998 to 8.47% in 2007. Women accounted for 71.6% of cases of negative appendectomy, and men accounted for 28.4%. The mortality rate was 1.07%, men were associated with a higher rate of mortality (1.93% vs .74%; P < .001). Ovarian cyst was the most common diagnosis mistaken for appendicitis in younger women, whereas malignant disease of the ovary was the most common condition mistaken for appendiceal disease in women ages 45 and older. The most common misdiagnosis in men was diverticulitis of the colon.CONCLUSIONS:
There has been a consistent decline in the rates of negative appendectomy. This trend may be attributed to better diagnostics. Gynecologic conditions involving the ovary are the most common to be misdiagnosed as appendiceal disease in women.Copyright © 2011 Elsevier Inc. All rights reserved.
Am J Obstet Gynecol. 2011 Jan;204(1):28.e1-5.
Laparoscopic incidental appendectomy during laparoscopic surgery for ovarian endometrioma.
Source
Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.Abstract
OBJECTIVE:
We sought to investigate the safety and efficacy of laparoscopic incidental appendectomy during laparoscopic surgery for endometrioma.STUDY DESIGN:
We conducted a retrospective study of 356 patients undergoing laparoscopic surgery for endometrioma with appendectomy (appendectomy group, n = 172) or not (nonappendectomy group, n = 184). Primary outcome measures were operating time, hemoglobin change, hospital stay, return of bowel activity, and any complications. The secondary outcome was appendiceal histopathology.RESULTS:
There were no statistical differences between groups in operating time, postoperative changes in hemoglobin concentration, hospital stay, return of bowel activity, or complication rate. Of the 172 resected appendices, 52 had histopathologically confirmed abnormal findings including appendiceal endometriosis in 16.CONCLUSION:
Incidental appendectomy at the time of laparoscopic surgery for endometrioma does not increase operative morbidity, and it has considerable diagnostic and preventive value. However, a large prospective randomized study is needed in the future to confirm this conclusion.Copyright © 2011 Mosby, Inc. All rights reserved.
JSLS. 2009 Jul-Sep;13(3):376-83.
Incidental appendectomy during endoscopic surgery.
Source
Oak Brook Institute of Endoscopy, Rush Medical College, St. Charles, Illinois, USA.Abstract
BACKGROUND AND OBJECTIVES:
The first laparoscopic appendectomy was performed over 25 years ago, and yet controversy still exists over the open method vs. the laparoscopic approach, and whether an incidental appendectomy is warranted. This study aimed to evaluate our experience in performing a laparoscopic incidental appendectomy and to address these issues.METHODS:
A total of 772 laparoscopic appendectomies were performed and analyzed and statistically evaluated.RESULTS:
Mean age of the patients was 30.8+/-7.0 years. Mean operating time for an incidental appendectomy was 12.3+/-4.5 minutes. Most common pathology result was adhesions, and the rarest was endometriosis. Of patients with confirmed appendicitis, 75.8% did not have an initial preoperative diagnosis of appendicitis. When warranted, 103 (13.3%) patients underwent a second-look laparoscopy: 75.5% had no adhesions, 23.5% had mild adhesions, 2% had moderate adhesions. Backward elimination logistic regression revealed that endometriosis (P=0.016), endometrioma (P=0.039), pelvic or abdominal adhesions (P=0.015) were associated with a reduced likelihood of encountering appendicitis on pathology examination. The complication rate was 0.13%. Anesthesia cost was lower for an incidental appendectomy compared with an urgent one.CONCLUSION:
Laparoscopic incidental appendectomy is safe and quick to perform. Due to the complex nature of confirming the diagnosis of pelvic and abdominal pain, this study supports the routine performance of an incidental appendectomy in the female patient.
Supplemental Content
- Improved outcomes for laparoscopic appendectomy compared with open appendectomy in the pediatric population. [J Laparoendosc Adv Surg Tech A. 2007] Improved outcomes for laparoscopic appendectomy compared with open appendectomy in the pediatric population.Schmelzer TM, Rana AR, Walters KC, Norton HJ, Bambini DA, Heniford BT. J Laparoendosc Adv Surg Tech A. 2007 Oct; 17(5):693-7.
- Laparoscopic appendectomy in children with perforated appendicitis. [J Laparoendosc Adv Surg Tech A. 2006] Laparoscopic appendectomy in children with perforated appendicitis.Nadler EP, Reblock KK, Qureshi FG, Hackam DJ, Gaines BA, Kane TD. J Laparoendosc Adv Surg Tech A. 2006 Apr; 16(2):159-63.
- The safety of incidental appendectomy at the time of abdominal hysterectomy. [Am J Obstet Gynecol. 2003] The safety of incidental appendectomy at the time of abdominal hysterectomy.Salom EM, Schey D, Peñalver M, Gómez-Marín O, Lambrou N, Almeida Z, Mendez L. Am J Obstet Gynecol. 2003 Dec; 189(6):1563-7; discussion 1567-8.
- Review [Laparoscopic or open appendectomy. Critical review of the literature and personal experience]. [G Chir. 2001] Review [Laparoscopic or open appendectomy. Critical review of the literature and personal experience].Cariati A, Brignole E, Tonelli E, Filippi M, Guasone F, De Negri A, Novello L, Risso C, Noceti A, Giberto M, et al. G Chir. 2001 Oct; 22(10):353-7.
- Review Appendix tumors in the era of laparoscopic appendectomy. [Surg Endosc. 2004] Review Appendix tumors in the era of laparoscopic appendectomy.Bucher P, Mathe Z, Demirag A, Morel P. Surg Endosc. 2004 Jul; 18(7):1063-6. Epub 2004 May 27.
- Related Citations Calculated set of PubMed citations closely related to the selected article(s) retrieved using a word weight algorithm. Related articles are displayed in ranked order from most to least relevant, with the “linked from” citation displayed first.
- References for this PMC Article Citation referenced in PubMed article. Only valid for PubMed citations that are also in PMC.
Aust N Z J Obstet Gynaecol. 2008 Feb;48(1):107-11.
Is incidental appendectomy necessary in women with ovarian endometrioma?
Source
Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.Abstract
BACKGROUND:
Several studies reported that pathology of the appendix is frequently detected alongside endometriosis, especially with chronic pelvic pain. Furthermore, ovarian endometriosis is a marker of more extensive pelvic and intestinal disease.AIMS:
To evaluate the feasibility and efficacy of incidental appendectomy in laparoscopic surgical treatment for ovarian endometrioma.METHODS:
One hundred and six women with ovarian endometrioma underwent laparoscopic surgery including laparoscopic appendectomy. Clinicopathological data were collected and analysed.RESULTS:
The main symptoms consisted of lower abdominal pain in 51 (48.1%) women, dysmenorrhoea in 23 (21.7%), left lower quadrant pain in 6 (5.7%), right lower quadrant pain in nine (8.5%), chronic pelvic pain in five (4.7%), and others in 12 (11.3%). Only three (3.3%) of the 106 women had abnormal findings on gross inspection during laparoscopic surgery: two women with endometriotic spots on the surface of their appendixes, and one with peri-appendiceal inflammation with severe adhesions. Of the 106 resected appendixes, 37 (34.9%) had histopathologically confirmed pathology including lymphoid hyperplasia in 12 (11.3%), endometriosis in 14 (13.2%), peri-appendicitis and serositis in five (4.7%), carcinoid tumour in three (2.8%), and others in three (2.8%).CONCLUSIONS:
In all surgical treatments for ovarian endometrioma, surgeons need to preoperatively inform the patients of the fact that appendiceal pathology including endometriosis is found frequently regardless of concurrent symptoms or gross finding of the appendix. Furthermore, surgeons should take into account the possibility of appendiceal pathology during operation.Am J Obstet Gynecol. 2003 Dec;189(6):1563-7; discussion 1567-8.
The safety of incidental appendectomy at the time of abdominal hysterectomy.
Source
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine, University of Miami/Jackson Memorial Hospital, 1611 NW 12th Avenue, Holtz Building East Tower Room 3003, Miami, FL 33136, USA. esalom@med.miami.eduAbstract
OBJECTIVE:
The purpose of this study was to assess the complication rates of incidental appendectomies in women who undergo benign gynecologic procedures.STUDY DESIGN:
This was a retrospective case-controlled study of patients who did (n=100 women) or did not (n=100 women) undergo incidental appendectomies at the time of an abdominal hysterectomy between June 1995 and January 2001. Information was abstracted from hospital and clinic records and a gynecologic oncology database. Data were obtained about age, body mass index, hypertension, diabetes mellitus, the number of days with nothing by mouth, the length of hospital stay, and postoperative complications (cellulitis, fever, ileus, pneumonia, thromboembolic disease). Data were analyzed with the use of two-sample t tests, Wilcoxon Rank sum tests, chi(2) tests, and multiple logistic regressions.RESULTS:
There was no difference in preoperative diagnosis or operative procedure for either group. The number of patients in the group that did have incidental appendectomy versus the group that did not have incidental appendectomy with additional procedures at the time of abdominal hysterectomy was bilateral salpingo-oophorectomy (66 vs 61 women), unilateral oophorectomy (19 vs 19 women), lysis of adhesions (9 vs 8 women), and others (12 vs 8 women). Compared with the group that did not have incidental appendectomy, the group that did have incidental appendectomy was younger (mean age+/-SD: 44+/-9.6 years vs 48+/-13.6 years, P=.02) and had a lower mean body mass index (26.1+/-6.0 kg/m(2) vs 29.8+/-8.9 kg/m(2), P=.0009). No significant differences were found between the two groups (the group that did have incidental appendectomy vs the group that did not have incidental appendectomy, respectively) with respect to the following postoperative complications: fever (40 vs 27 women), cellulitis (1 vs 2 women), wound collection (4 vs 6 women), wound dehiscence (1 vs 5 women), wound abscess (7 vs 6 women), ileus (3 vs 2 women), and urinary tract infection (4 vs 10 women). The mean length of hospital stay was significantly longer in the group that did have incidental appendectomy than in the group that did not have incidental appendectomy (3.6+/-1.52 days vs 3.1+/-1.1 days, P=.006). However, the difference was no longer significant when patients who were fed electively on the postoperative day 2 were excluded from the analysis (3.16+/-1.13 days vs 3.04+/-1.13 days, P=.507). Thirty-one percent of the histologic specimens were abnormal, with fibrous obliteration being most common, and there was one case of acute appendicitis.CONCLUSION:
An incidental appendectomy at the time of benign gynecologic procedures does not increase postoperative complication rates or length of hospital stay. The inclusion of incidental appendectomies in all abdominal hysterectomies could potentially decrease the morbidity and mortality rates because of appendicitis in elderly women.J Okla State Med Assoc. 2003 Sep;96(9):431-3.
Appendectomy at the time of cesarean section.
Source
Saint Anthony Hospital, 608 NW 9th St., Suite 1000 OKC, OK 73102, USA.Abstract
The current world literature estimates the incidence of appendicitis in pregnancy at approximately 1 case per 1500 normal deliveries. Observations of one physician and review of records from Saint Anthony Hospital in Oklahoma City have suggested potential benefit to routine examination of the appendix at the time of cesarean section and removal if it appears pathologic. The medical literature was reviewed regarding appendicitis in pregnancy and incidental or indicated appendectomy at the time of cesarean section. Many authors have described difficulties with diagnosis, as well as potential complications of appendicitis in pregnancy. Studies have confirmed the safety of performing incidental appendectomy at the time of cesarean section. The authors, therefore, propose that clinicians visualize and palpate the appendix at all cesarean sections, and remove those with evidence of inflammation or disease.Infect Dis Obstet Gynecol. 1998;6(1):30-7.
Incidental appendectomy--yes or no? A retrospective case study and review of the literature.
Source
Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.Abstract
OBJECTIVE:
A retrospective review of appendectomies performed at the University of Kansas Medical Center between January 1, 1989, and January 1, 1994, was conducted. In addition, the literature evaluating effectiveness of incidental appendectomy in preventing future operation and morbidity from appendicitis was reviewed. The results of the two reviews were analyzed to formulate guidelines for the appropriateness of performing incidental appendectomy in association with other operative procedures.METHOD:
A retrospective review of results of appendectomies performed in 460 patients at the University of Kansas Medical Center with analysis of operative findings, pathology of the removed appendix and operative complications was performed. These results were compared with those of a systematic review of the literature utilizing a Medline search relating to the subject of incidental appendix removal.RESULTS:
Two hundred sixty-one incidental appendectomies were performed in this study of 460 patients (60%). The procedure was most commonly performed with total abdominal hysterectomy (56%), followed by oophorectomy (15%) and exploratory laparotomy (11%). Morbidity was minimal at all ages. Microscopic pathology was found in 25% of the cases.CONCLUSION:
The data from the current survey and literature review support incidental removal of the appendix in the young patient (< 35 years old). In patients 35-50 years old the literature is controversial, and the patient's clinical condition and judgment of the operating surgeon should determine whether incidental appendectomy should be performed. However, routine incidental appendectomy cannot be justified in patients greater than age 50.J Am Coll Surg. 2001 Feb;192(2):182-8.
Incidental appendectomy in the era of managed care and laparoscopy.
Source
Department of Surgery, University of Rochester Medical Center, NY 14642-8410, USA.Abstract
BACKGROUND:
In a study carried out before laparoscopy or managed care, there was no cost or patient benefit for routine incidental appendectomy. With the onset oflaparoscopy, a change in indications for surgery, and increased prevalence of capitated contracts, a reanalysis of the cost-effectiveness of incidental appendectomy is warranted.STUDY DESIGN:
Financial data from 251 patients undergoing appendectomy for acute appendicitis without complication at a single institution were identified. Age-specific epidemiology data from the Centers for Disease Control, Atlanta, were applied to assess risk and cost of future appendectomy. The net cost or savings for incidental appendectomies necessary to prevent one case of acute appendectomy was determined and stratified by gender and age to the population as a whole. Further adjustment was made for the variable level of surgeon reimbursement for incidental appendectomy.RESULTS:
At 10% surgeon reimbursement, open incidental appendectomy was cost-effective in those less than 25 years of age (< 35 years of age in a capitated system). Applied to the general population, open incidental appendectomy in those less than 25 years represented savings of up to $1,100 per 10,000 population per year. A surgeon fee of greater than 50%, or the laparoscopic approach using staplers, accrued no savings in any age groups.CONCLUSIONS:
Open incidental appendectomy at low physician reimbursement is a cost-effective procedure for patients of less than 35 years of age. A decrease in equipment cost for laparoscopic approach will extend these indications.Surg Endosc. 1998 Mar;12(3):223-5.
Incidental laparoscopic appendectomy for acute right lower quadrant abdominal pain. Its time has come.
Source
Department of General Surgery and Clinical Investigation, Naval Medical Center, 34800 Bob Wilson Drive, San Diego, CA 92134-5000, USA.Abstract
BACKGROUND:
Removing the normal appendix when operating for suspected acute appendicitis is the standard of care. The use of laparoscopy should not alter this practice.METHODS:
Retrospective review of 72 patients found to have grossly normal appendices while undergoing laparoscopy for suspected appendicitis. Twenty-eight patients underwent diagnostic laparoscopy (DL) alone while 44 patients underwent diagnostic laparoscopy with incidental laparoscopic appendectomy (ILA).RESULTS:
There was no difference in length of hospitalization (DL = 44 h, ILA = 43 h, p = 0.49) or morbidity (DL = 11%, ILA = 5%, p = 0.37). One patient required appendectomy 11 days after diagnostic laparoscopy for recurrent acute right lower quadrant abdominal pain. Five percent of resected appendices (2/44) demonstrated acute inflammation upon pathologic review.CONCLUSIONS:
Laparoscopic removal of the normal appendix produces no added morbidity or increase in length of hospitalization as compared to diagnostic laparoscopy. It demonstrates cost effectiveness by preventing missed and future appendicitis. Incidental laparoscopic appendectomy is the preferred treatment option.J Laparoendosc Surg. 1992 Aug;2(4):165-6.
Incidental appendectomy during laparoscopic cholecystectomy.
Source
Department of Surgery, Staten Island University Hospital, NY 10305.Abstract
An operative experience of three patients who underwent incidental laparoscopic appendectomy during laparoscopic cholecystectomy is presented. The technique and indications are discussed. The authors conclude that incidental laparoscopic appendectomy is possible and safe with existing incisions performed in gallbladder surgery. However, well-controlled prospective studies should be performed prior to wide application of this technique.Todays OR Nurse. 1991 Dec;13(12):12-8.
Laparoscopic appendectomy incidental to gynecologic procedures.
Abstract
1. The advantages of laparoscopic appendectomy over the traditional "open" method include decreased chance of wound infection, early ambulation and resumption of normal daily activities, decreased postoperative pain, improved diagnostic accuracy, better visualization of intra-abdominal anatomy, improved cosmetic results, and avoidance of "open" appendectomy if pathology is found during routine gynecologic laparoscopic surgery. 2. Single-puncture laparoscopy has several advantages over the multiple-puncture approach, including simplicity, expediency, lower cost, avoidance of potential complications associated with multiple punctures, improved cosmetic results, and flexibility to be converted into multiple-puncture laparoscopy or laparotomyAm J Obstet Gynecol. 1991 Sep;165(3):559-64.
Incidental appendectomy during videolaseroscopy.
Source
Fertility and Endoscopy Center, Laser Endoscopy Institute of Atlanta, GA 30342.Abstract
One hundred incidental appendectomies were performed in patients undergoing operative laparoscopy (videolaseroscopy) for evaluating and treating various major diseases of the reproductive organs. Except for a fever resolving within 24 hours in one case and mild periumbilical ecchymosis, there were no intraoperative or postoperative complications. All patients were discharged within 24 hours of surgery. Average hospital stay was 14 hours. All cases have been followed up for a minimum of 8 months. We believe any risk associated with elective appendectomy as reported here is minimal and outweighed by the benefits of eliminating future emergency appendectomy, simplifying future differential diagnosis of pelvic pain and removing unsuspected abnormality found in the appendix.Surg Laparosc Endosc. 1991 Jun;1(2):116-8.
Laparoscopic incidental appendectomy.
Abstract
The benefits and risks of laparoscopic incidental appendectomy are discussed. We believe a case for laparoscopic incidental appendectomy can be made for patients undergoing diagnostic laparoscopy for lower abdominal pain in whom either no cause is found, or in whom a cause other than appendicitis is discovered. No benefit from incidental appendectomy can be shown for patients undergoing laparoscopy for other disorders.Surg Gynecol Obstet. 1990 Jul;171(1):95-8.
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