Abstract
Background
Owing to substantial costs and increasing interest in the nonoperative management
of appendicitis, the necessity of routine histopathologic examination of appendectomy
specimens is being questioned. The aim of this study was to determine whether routine
histopathologic examination after appendectomy for suspected appendicitis should still
be performed.
Methods
PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies
listing the histopathologic diagnoses after appendectomy for suspected appendicitis.
Main outcomes were the incidence of histopathologically proven aberrant findings,
the ability of surgeons to recognize unexpected appendiceal pathology intraoperatively,
and the percentage of aberrant findings resulting in a change of postoperative management.
A meta-analysis was performed using a random-effects model.
Results
Twenty-five studies with 57,357 patients were included. The pooled percentage of aberrant
findings was 2.52% (95% confidence interval 1.81–3.51). Neoplasms were found in 0.71%
(95% confidence interval 0.54–0.94). Findings of the intraoperative assessment by
the surgeon were reported for 82 of the 2,718 (3.0%) unexpected diagnoses, with great
variation between studies. The impact on postoperative management was described for
237 of 2,718 (8.7%) aberrant findings. Of these, 166 (70.0%) resulted in a change
of postoperative management.
Conclusion
Based on current evidence, it remains unclear how many of the unexpected appendiceal
pathologies with clinical consequences can be identified intraoperatively by the surgeon.
Until reliable data on the safety and potential cost savings of a selective policy
becomes available, we advise sending appendectomy specimens routinely for histopathologic
examination.
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Article info
Publication history
Published online: May 27, 2020
Accepted:
March 31,
2020
Identification
Copyright
© 2020 Published by Elsevier Inc.
