Negative appendicectomy and perforation rates in patients undergoing laparoscopic surgery for suspected appendicitis (Br J Surg 2011; 98: 589-595)

Abstract Aims To evaluate the effectiveness of using a clinical prediction tool in the management of suspected acute appendicitis Methods Retrospective data was collected on patients undergoing appendicectomy at a single tertiary centre from November 2019 to June 2020. Inclusion criteria were all patients aged 18 and above undergoing diagnostic laparoscopy for suspected appendicitis. Exclusion criteria were all patients that had a pathological finding other than appendicitis at laparoscopy. The pre operative AAS score at first presentation was calculated and patients grouped into low(0-10), intermediate(11-15), and high(16 and above) risk. These groups were then compared to the histological findings. Results A total of 74 patients were included, 44 male and 30 female. The age range was from 18 to 83, with a median age of 36. Of 10 patients in the low risk group, 4 (40%) had appendicitis on histology. 36 out of 40 (90%) patients in the intermediate risk group had appendicitis and 100% of the 24 patients in the high risk group. Pearson’s coefficient showed a significant correlation between the AAS risk (low, intermediate, and high) and the histological diagnosis of appendicitis (r = 0.48, p = 0.000016). Conclusions Our study did show a positive correlation between the AAS risk stratification and histological diagnosis. Based on our findings we would recommend the adoption of this score in assessing patients with suspected acute appendicitis and minimising the negative appendicectomy rate.

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Diagnostic Role of Pediatric Appendicitis Score (PAS) in Appendicitis of Children

Journal of Paediatric Surgeons of Bangladesh ◽

10.3329/jpsb.v6i1.27742 ◽

2016 ◽

Vol 6 (1) ◽

pp. 16-19

Author(s):

Susankar Kumar Mondal ◽

AKM Zahid Hossain ◽

Mizanur Rahman ◽

Gazi Zahirul Hasan ◽

Kaniz Hasina ◽

...

Keyword(s):

Predictive Value ◽

Age Group ◽

Good Tool ◽

Suspected Appendicitis ◽

Diagnostic Role ◽

Group 5 ◽

Negative Appendicectomy ◽

Sensitivity Specificity ◽

Appendicitis Score

Appendicitis is one of the most common causes of acute abdominal pain in pediatrics and is the most common indication for emergency abdominal surgery in childhood. The diagnosis of pediatric appendicitis remains challenging. To evaluate the role of pediatric appendicitis score (PAS) in the diagnosis of appendicitis of children.Methods: In this study, 200 suspected appendicitis patients attended in four private hospitals in old Dhaka city over a period of about 34 months from January 2011 to May 2014 were selected as study subjects. Patient age, sex and each of the eight PAS components were collected. Children who had PAS less than six were discharged and contacted by telephone upto 1 month to verify final outcome. Rest of the children with PAS equal or more than 6 were underwent appendectomy.Results: Two hundred patients were assessed in this study. Out of them 67 (33.5%) children had appendicitis and 76 (38.0%) children had PAS equal or more than 6. In appendicitis children, maximum (85.3%) children were in age group 10- 16 years and 10 (14.7%) patients were in age group 5-9 years.Male (73.5%) were predominant than female (26.5%) in appendicitis children. Migration of pain, nausea and anorexia were in 43 (63.2%), 45 (66.2%) and 48 (70.6%) appendicitis children respectively. Fever, cough/percussion tenderness and tenderness in RLQ were in 37 (54.4%), 52 (76.5%) and 59 (86.8%) appendicitis children respectively. Leukocytosis andneutophilia were present in 42 (61.8%) and 46 (67.6%) appendicitis children respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy rate of PAS were 80.6%, 83.5%, 71.1%, 89.5% and 82.5% respectively.Conclusion: Paediatric Appendicitis Score is a good tool but not good enough for diagnosis of paediatirc appedicitis. It cannot be recommended for diagnosis of paediatric appendicitis because its negative appendicectomy rate as well as wrongly discharged rate is high.J. Paediatr. Surg. Bangladesh 6(1): 16-19, 2015 (Jan)

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A comparison of intra-operative diagnosis to histopathological diagnosis of acute appendicitis in paediatric and adult cohorts: an analysis of over 1000 patients

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02770-5 ◽

2021 ◽

Author(s):

Johnathon Harris ◽

Christina A. Fleming ◽

Paul N. Stassen ◽

Daniel Mullen ◽

Helen Mohan ◽

...

Keyword(s):

Acute Appendicitis ◽

Histopathological Diagnosis ◽

Open Appendicectomy ◽

Normal Appendix ◽

Macroscopic Appearance ◽

Surgical Department ◽

Suspected Appendicitis ◽

Final Histological Diagnosis ◽

Negative Appendicectomy ◽

Operating Surgeon

Abstract Background Appendicitis is a common general surgical emergency. The role of removing a normal appendix is debated. However, this relies on accurate intra-operative diagnosis of a normal appendix by the operating surgeon. This study aimed to compare surgeon’s intra-operative assessment to final histological result acute appendicitis in paediatric and adult patients. Methods All patients who underwent appendicectomy over a 14-year period in a general surgical department were identified using the prospective Lothian Surgical Audit system and pathology reports retrieved to identify final histological diagnosis. Open appendicectomy was selected to examine, as the routine practise at our institution is to remove a normal appendix at open appendicectomy. Results A total of 1035 open appendicectomies were performed for clinically suspected appendicitis. Sensitivity of intra-operative diagnosis of appendicitis with operating surgeon was high at 95.13% with no difference between trainee and consultant surgeon or between adult and paediatric cases. Specificity of intra-operative diagnosis was lower in the paediatric group (32.58%) than in the adult group (40.58%). Women had a higher rate of negative appendicectomy than men. Conclusion The results of this study highlight some discordance between histological evidence of acute appendicitis and intra-operative impression. Therefore other clinical variables and not just macroscopic appearance alone should be used when deciding to perform appendicectomy.

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Long-term Follow-up for Adhesive Small Bowel Obstruction After Open Versus Laparoscopic Surgery for Suspected Appendicitis

Annals of Surgery ◽

10.1097/sla.0000000000000322 ◽

2014 ◽

Vol 259 (6) ◽

pp. 1173-1177 ◽

Cited By ~ 29

Author(s):

Karolin Isaksson ◽

Agneta Montgomery ◽

Ann-Cathrin Moberg ◽

Roland Andersson ◽

Bobby Tingstedt

Keyword(s):

Laparoscopic Surgery ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Adhesive Small Bowel Obstruction ◽

Suspected Appendicitis ◽

Long Term Follow Up ◽

Open Versus

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TP9.2.19Factors Associated with Multiple Presentations Prior to Appendicectomy in Children Presenting with Suspected Appendicitis

British Journal of Surgery ◽

10.1093/bjs/znab362.119 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

James Chean Khun Ng ◽

Vi June Tay ◽

Francesca Ligori Malcolm ◽

Zoe Chia ◽

Ahmed M El-Sharkawy ◽

...

Keyword(s):

Clinical Symptoms ◽

Discharge Rate ◽

White Cell Count ◽

Iliac Fossa ◽

Significant Proportion ◽

Initial Presentation ◽

Surgical Team ◽

Emergency Operations ◽

Suspected Appendicitis ◽

Negative Appendicectomy

Abstract Aims Appendicectomy is amongst the most common emergency operations in children. We aim to audit the rate of re-presentation within 30-days prior to appendicectomy in children presenting to the emergency department (ED) with suspected appendicitis and identify the factors associated with re-presentations. Methods Retrospective review of the medical notes of all children that had an emergency appendicectomies between June 2016 and June 2019. Results A total of 231 appendicectomies were performed, all presented through ED, with 8.2%(n = 19) re-presenting within 30-days prior to appendicectomy. Negative appendicectomy rates were similar in those that had appendectomy at initial presentation or when they re-presented (13.2(n = 28)%vs.15.8%(n = 3), p = 0.752), respectively. Of those that re-presented, 84.2%(n = 16) were not reviewed by the surgical team at the index presentation. Female patients accounted for 62.5%(n = 10) of those that re-presented, compared with 31%(n = 57) of those that presented once(p = 0.010). Pyrexia(p = 0.029), Rovsing's sign(p = 0.032), nausea or vomiting(p = 0.012) was associated with histological appendicitis. Absence of migratory pain(p = 0.005), anorexia(p = 0.004), right iliac fossa tenderness(p < 0.001) or guarding(p < 0.001) was associated with higher successful discharge rate. Among those re-presented, there was significant CRP rise between first and second presentation (median(Q1,Q3): 6(1.25,28.5)vs.95.5(27,176.5), p = 0.016) however, white cell count was comparable (median(Q1,Q3): 14.6(11.98,16.05)vs.14.0(11.02,18.58), p = 0.815). Conclusion Clinical symptoms and signs correlated with histological appendicitis. A significant proportion of those that re-presented were not assessed by the surgical team at initial presentation. Early surgical consultation at initial presentation may reduce rates of re-presentation.

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Incidence of Negative Appendicectomy: Correlation Between Clinical, Peroperative and Histopathological Findings

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v42i3.32217 ◽

2017 ◽

Vol 42 (3) ◽

pp. 142-146

Author(s):

Mohammad Zillur Rahman ◽

Johirul Islam ◽

Md. Hasanuzzaman ◽

Ahsan Habib ◽

Avisak Bhattachari

Keyword(s):

Acute Appendicitis ◽

Correct Diagnosis ◽

Reproductive Age ◽

Histological Evaluation ◽

Diagnostic Tools ◽

Histopathological Findings ◽

Suspected Appendicitis ◽

Female Patients ◽

Male Patients ◽

Negative Appendicectomy

Appendicitis is one of the most difficult diagnostic problems to confront the emergency physician and it is the most common intra-abdominal condition requiring emergency surgery. The term Negative appendicectomy used for operation done for suspected appendicitis, in which the appendix is found to be normal on histological evaluation. The study aimed to find out the incidence of negative appendicectomy evaluating the correlation between clinical, per-operative and histopathological findings. It was a prospective study of 100 cases clinically diagnosed as acute appendicitis selected over a period of one year (July 2006 to June 2007) from different surgical ward of Mymensingh Medical College Hospital. The study revealed a negative appendicectomy rate of 12%. Moreover, in all cases of acute appendicitis, there was a well established bias towards male patients and young male patients constituted the majority of the cases. But the rate of negative appendicectomy found to be higher in female patients, which is 15.9% as compared to only 8.92% male patients. In addition, among female patients differential diagnostic difficulties encountered in females of reproductive age group. More emphasis on technology at the expense of clinical evaluation is certainly responsible for the diminish in accuracy of diagnosis. The diagnosis of acute appendicitis remains essentially clinical, requiring a mixture of observation, clinical acumen and accurate use of diagnostic tools. A correct diagnosis is certainly important than a rapid diagnosis.

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Laparoscopic surgery compared to open surgery for suspected appendicitis

Kazan medical journal ◽

10.17816/kmj11023 ◽

2019 ◽

Vol 100 (1) ◽

pp. 190

Author(s):

Keyword(s):

Laparoscopic Surgery ◽

Open Surgery ◽

Suspected Appendicitis

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514 Audit to Assess Negative Appendicectomy Rate (NAR) in Adult Patients in The Leicester Royal Infirmary (LRI)

British Journal of Surgery ◽

10.1093/bjs/znab134.442 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Baguley ◽

T Palser

Keyword(s):

False Positive Rate ◽

National Average ◽

Royal Infirmary ◽

Obese Patients ◽

Suspected Appendicitis ◽

Retrospective Audit ◽

Positive Rate ◽

Secondary Objective ◽

Negative Appendicectomy ◽

Leicester Royal Infirmary

Abstract Aim: Determine the NAR rate in Leicester Royal Infirmary (LRI) and compare to the national average (20%) Additional objectives: Method This was a retrospective audit which considered all patients admitted over a three-month period to the LRI with suspected appendicitis. Data was collected on patients proceeding to surgery, and then whether their histology was pathological. Results 318 patients were included, of which 80 proceeded to surgery. Objective 1 - NAR of 5% (4/80) Secondary objective 1 Secondary objective 2 - Appendix visualised in 29.3% (48/164) of Ultrasounds Conclusions This audit has demonstrated that both USS and CT have a very low false-positive rate in assessment of appendicitis; however, USS visualises the appendix in less than 30% of cases. I believe the pathway should be altered to remove USS scanning for obese patients where the appendix is difficult to visualise; or in older patients, where there is less concern in using the CT modality.

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