Acute appendicitis: is removal of a normal appendix still existing and can we reduce its rate?
OBJECTIVE
To determine the incidence of negative appendectomies and to identify factors that may reduce the risk of having the normal appendices removed surgically.


METHODS
Cross-sectional study.


METHODS
College of Medicine and King Khalid University Hospital, Riyadh, Saudi Arabia.


METHODS
The surgical and histological data of 852 patients who underwent appendicectomy were reviewed. All incidental or interval appendicectomies were excluded. Only patients who were admitted and whose appendices were removed and subjected to histology were included (585 patients). The data on patients who had a normal appendix on histology further analyzed to include demographics, specific investigations, operative findings of the appendix and additional operative findings that need other surgical procedures.


RESULTS
A normal appendix was removed in 54 (9.2%) of the patients. Only 5.5% of those patients had a computed tomography (CT) scan preoperatively and 3.7% had diagnostic laparoscopy. In 21 patients, additional operative and histological findings were obtained that might have caused the right lower abdominal pain.


CONCLUSIONS
In spite of the advances in the diagnostic and imaging techniques, the rates of negative findings on appendicectomy have not decreased much. Clinical judgment is still the most important factor in the management of patients with suspected acute appendicitis. The routine use of CT scan or diagnostic laparoscopy for all patients who are suspected to have appendicitis is neither cost-effective nor safe.
Khairy
Gamal
G
Division of General Surgery, Department of Surgery, Riyadh - 11472, Kingdom of Saudi Arabia. gkhairy@ksu.edu.sa
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000175:diagnosis / Q000601:surgery*; D001065:Appendix / Q000601:surgery*; D002648:Child; D003951:Diagnostic Errors / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult