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
ARTICLE HIGHLIGHTS
Research 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.

Research objectives

The aim of this study was to compare the clinical and histopathological parameters of patients who underwent incidental appendectomy during donor hepatectomy with the patients who underwent appendectomy for acute appendicitis.

Research methods

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

Research results

Statistically significant differences were found between groups in terms of age (P = 0.044), white blood cell (P < 0.001), neutrophil (P < 0.001), lymphocyte (P < 0.001), red cell distribution width (P = 0.031), mean corpuscular hemoglobin (P = 0.001), bilirubin (P = 0.002), appendix width (P < 0.001), and presence of acute appendicitis (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, or appendix length. While the most common histopathological findings in the Incidental Appendectomy group were 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 (6.3%), and appendix vermiformis (6.3%).

Research conclusions

We do not recommend performing incidental appendectomy in every major abdominal operation. We think that experience is parallel to the surgeon’s foresight and should not hesitate to perform an incidental appendectomy when necessary.

Research perspectives

During major abdominal surgery such as living donor hepatectomy, the peritoneal cavity should be gently explored thoroughly and that appendectomy should be performed if there are any suspicious findings without clinical contraindication.