Macroscopic findings at appendicectomy are unreliable: implications for laparoscopy and malignant conditions of the appendix.

Background: At laparoscopic appendicectomy, some surgeons leave a macroscopically normal appendix in situ. To assess if this is safe practice, the authors wanted to identify the correlation between macroscopic findings at appendicectomy and pathologists' assessment with regard to the inflamed and the neoplastic.

Method: Operative cases and histological findings over a 3-year period were identified.

Results: The authors obtained 876/972 notes (90.1%). There was 100% congruity between surgeons and pathologists when perforation, abscess, or gangrene of the appendix was noted (n = 235). Where inflammation was the sole recorded finding, 8.3% of cases (37/445) were histologically normal; 33.1% (47/139) of appendices perceived to be normal at appendicectomy demonstrated histological signs of inflammation. Of 16 neoplastic lesions only 3 were identified at the time of surgery.

Conclusions: Surgeons' ability to diagnose a normal appendix is poor as is the ability to detect neoplastic lesions. At laparoscopy, to investigate acute abdominal pain a macroscopically normal appendix should be removed.