Published online Jan 27, 2019. doi: 10.4240/wjgs.v11.i1.19
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
Processing time: 107 Days and 16.5 Hours
Incidental appendectomy can be defined as the removal of a clinically normal appendix during another surgical procedure unrelated to appendicitis or other appendicular diseases.
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.
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.
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%).
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.
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.