Non-therapeutic appendectomy: 1-year review at the Pereira Rossell Hospital Center, Montevideo, Uruguay
Abstract
Objectives: Acute appendicitis is one of the most frequent pediatric surgical diseases and appendectomy is a historically proved treatment. However, attention has been directed at morbidity and costs of negative appendectomy (NA). Here we analyze the incidence of NA at our hospital and its characteristics in order to propose a working hypothesis that allows a decrease in its incidence.
Methods: A retrospective analysis including all patients who underwent surgery from 01/01/13 to 31/12/13, with presumptive clinical diagnosis of acute appendicitis, in the Pediatric Hospital of the Pereira Rossell Hospital Center, was done. Age, sex, surgical approach, operative findings, pathologic diagnosis and the use and results of laboratory and ultrasound, were analyzed.
Results: In the referred period, appendectomies were performed in 287 patients with diagnosis of acute appendicitis, of which 146 (50.87%) were operated by a conventional approach and 141 (49.13%) by laparoscopic approach.The NA were 10.10%, with similar rates for both approaches (10.27% vs 9.92%, conventionalvs laparoscopic).A higher incidence of of NA was evident in girls, (16,6% vs 5,8%, conventionalvs laparoscopic). With respect to the age group, the rate of NA was higher among 11-15 years old patients (12,19%), while for those aged between 6-10 years it was 8.08 % and for patients aged 0-5 years it was 4.16%. Of the 29 patients who had a healthy appendix, 12 had mesenteric adenitis, one patient had a follicular rupture and other had a medical peritonitis.In 15 patients no other abnormalities were found.
Conclusions: The NA rate at our Hospital was 10.10% during 2013. The international experience and some national works prove that this result is improvable. We propose the utilization of clinical scores in order to improve clinical diagnostic and rational use of ancillary resources and the installation of a prospective registry and analysis system of results in acute appendicitis.
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