Negative appendicectomy and perforation rates in patients undergoing laparoscopic surgery for suspected appendicitis

  • Author: U. Güller, L. Rosella, J. McCall, L. E. Brügger, D. Candinas

Your View

Sir,

As we note in our article, although the database of the Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS) used in the present study has numerous strengths, it also has several important limitations. First, it contains only information on patients who underwent laparoscopic appendectomies (or who were converted from a laparoscopic to an open procedure). For this reason, we were not able to assess the rate of negative appendectomies and perforated appendices in the entire patient population with symptoms of acute appendicitis.

Regarding Dr. Wysocki’s second point, of the 7964 patients included in this study, 7452 had a macroscopically inflamed appendix. However, as described in our article, 512 did not have a macroscopically inflamed appendix (i.e., negative appendectomy patients). While the SALTS database does contain very complete information on many important variables, unfortunately, there is no available information regarding the pathology of the removed appendix, although we certainly agree that this represents an interesting avenue for further investigation.

Finally, we fully agree that performing a negative appendectomy is associated with a number of potential short- and long-term sequelae, as well as considerable cost. Clearly, there is a trend toward better selection of patients with right lower quadrant pain and more frequent use of imaging which allows the diagnosis of other pathologies. We also agree that these are likely to be significant factors in the reduction in the rate of negative appendectomy observed in our study, although this with the associated economic implications, awaits further study.

Ulrich Guller, Laura Rosella, Jonathan McCall, Lukas Brugger, Daniel Candinas
ulrich.guller@gmail.com

  • Commentor: Ulrich Guller, Laura Rosella, Jonathan McCall, Lukas Brugger, Daniel Candinas
  • Date: Apr 26, 2011

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