Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2019; 11(1): 19-26
Published online Jan 27, 2019. doi: 10.4240/wjgs.v11.i1.19
Comparison of clinical and histopathological features of patients who underwent incidental or emergency appendectomy
Sami Akbulut, Cemalettin Koc, Huseyin Kocaaslan, Fatih Gonultas, Emine Samdanci, Saim Yologlu, Sezai Yilmaz
Sami Akbulut, Cemalettin Koc, Huseyin Kocaaslan, Fatih Gonultas, Sezai Yilmaz, Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Emine Samdanci, Department of Pathology, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Saim Yologlu, Department of Biostatistics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Author contributions: Akbulut S, Koc C, Kocaaslan H, and Gonultas F contributed to data collection and manuscript writing; Akbulut S and Yilmaz S contributed to project development and manuscript writing; Samdanci E contributed to histopathological analysis; Yologlu S contributed to statistical analysis.
Institutional review board statement: This study was reviewed and approved by the Inonu University Rectorate Ethics Committee.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to living donor hepatectomy by written consent.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sami Akbulut, MD, Associate Professor, Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km, Malatya 44280, Turkey. akbulutsami@gmail.com
Telephone: +90-422-3410660
Received: October 13, 2018
Peer-review started: October 13, 2018
First decision: October 18, 2018
Revised: December 13, 2018
Accepted: December 29, 2018
Article in press: December 30, 2018
Published online: January 27, 2019
Abstract
BACKGROUND

Incidental appendectomy can be defined as the removal of a clinically normal appendix during another surgical procedure unrelated to appendicitis or other appendicular diseases.

AIM

To compare the demographic, biochemical, and histopathological features of the patients who underwent incidental and standard appendectomy.

METHODS

The demographic, biochemical, and histopathological data of 72 patients (Incidental App group) who underwent incidental appendectomy during living donor hepatectomy at our Liver Transplant Center between June 2009 and December 2016 were compared with data of 288 patients (Acute App group) who underwent appendectomy for presumed acute appendicitis. The Incidental App group was matched at random in a 1:4 ratio with the Acute App group in the same time frame. Appendectomy specimens of both groups were re-evaluated by two experienced pathologists.

RESULTS

Statistically significant differences were found between groups in terms of age (P = 0.044), white blood cell count (P < 0.001), neutrophil (P < 0.001), lymphocyte (P < 0.001), red cell distribution width (P = 0.036), mean corpuscular hemoglobin (P = 0.001), bilirubin (P = 0.002), appendix width (P < 0.001), and presence of acute appendicitis histopathologically (P < 0.001). However, no statistically significant differences were found between groups in terms of gender, platelet, mean platelet volume, mean corpuscular volume, platelet distribution width, appendix length. While the most common histopathological findings in the Incidental App group were normal appendix vermiformis (72.2%), fibrous obliteration (9.7%) and acute appendicitis (6.9%), the most common histopathological findings in the Acute App group were non-perforated acute appendicitis (62.8%), perforated appendicitis (16.7%), lymphoid hyperplasia (8.3%), and appendix vermiformis (6.3%).

CONCLUSION

Careful inspection of the entire abdominal cavity is useful for patients undergoing major abdominal surgery such as donor hepatectomy. We think that experience is parallel to the surgeon’s foresight, and we should not hesitate to perform incidental appendectomy when necessary

Keywords: Living donor hepatectomy, Incidental appendectomy, Acute appendicitis

Core tip: Incidental appendectomy is defined as resection of the appendix vermiformis in necessary situations such as a pathologic finding during abdominal operations performed for other reasons. A question remains as to whom incidental appendectomy should be performed. In this study, we compared demographic, biochemical, and histopathological features of the patients who underwent incidental appendectomy during living donor hepatectomy with patients who underwent appendectomy for presumed acute appendicitis.