Discrepancies between intraoperative and histological evaluation of the appendix in acute appendicitis
Abstract
Purpose To identify discrepancies between intraoperative and histological evaluations of the appendix in acute appendicitis and to evaluate the effect on surgical outcome. Methods Data was used from our previous multicentre, prospective, cohort study of patients with suspected acute appendicitis. Appendices were scored during intraoperative and histological evaluation as uncomplicated or complicated appendicitis. Primary outcome was percentage of concordance between intraoperative and histological evaluation. Secondary outcomes were (infectious) postoperative complications, length of hospital stay, hospital re-admission and re-intervention rate, all within 30 days of surgery. Results A total of 1850 patients were included. In 65.7% (1215/1850) of the appendices, the intraoperative evaluation was uncomplicated and in 34.3% (635/1850), complicated appendicitis. Patients with uncomplicated appendicitis had a postoperative course with significantly less postoperative complications (7.2% vs 24.3%), a shorter length of hospital stay (2 vs 5 days) and a lower re-admission (4.2% vs 9.6%) and re-intervention rate (1.1% vs 4.3%) than intraoperative complicated appendicitis (p Conclusions There is a moderate agreement between a surgeon and pathologist in diagnosing patients with complicated appendicitis. However, the intraoperative diagnosis of complicated appendicitis was significantly associated with postoperative complications. Routine histological evaluation should be preserved for…
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Negative appendectomy (histologically normal appendix despite clinical suspicion of appendicitis) has been reported in 10% to 20% of cases, and up to 30% in specific populations such as young women and children.
“This phenomenon, often referred to as a “negative appendectomy,” has been reported in 10% to 20% of cases, and up to 30% in specific populations such as young women and children [33,34].”
From Selective Appendectomy in Patients Undergoing Minimally Invasive Surgery for Endometriosis: A Retrospective Cohort Study (2025) · cites this paper as [33]
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“This phenomenon, often referred to as a “negative appendectomy,” has been reported in 10% to 20% of cases, and up to 30% in specific populations such as young women and children [33,34].”
- Authors
- Bolmers, M. D. M., de Jonge, J., van Rossem, C. C., van Geloven, A. A. W., Bemelman, W. A., Van Acker, G. J., Akkermans, B., Akkersdijk, G. J., Algie, G. D., Allema, J. H., Andeweg, C. S., Appeldoorn, N., van Baal, J. G., den Bakker, C. M., Bartels, S. A., van den Berg, C., Boekestijn, B., den Boer, F. C., Boerma, D., van den Boom, A. L., Boute, M. C., Bouwense, S. A., Bransen, J., van Brussel, F. A., Busch, O. R., de Castro, S. M., Cense, H. A., Croese, C., van dalen, T., Dawson, I., van Dessel, E., Dettmers, R., Dhar, N., Dohmen, F. Y., van Dongen, K. W., van Duijvendijk, P., Dulfer, R. R., Dwars, B. J., Eerenberg, J. P., van der Elst, M., van den Ende, E., Fassaert, L. M., Fikkers, J. T., Foppen, J. W., Furnee, E. J., Garssen, F. P., Gerhards, M. F., van Goor, H., de Graaf, J. S., Graat, L. J., Grootr, J., van der Ham, A. C., Hamming, J. F., Hamminga, J. T., van der Harst, E., Heemskerk, J., Heijne, A., Heikens, J. T., Heineman, E., Hertogs, R., van Heurn, E., van den Hil, L. C., Hooftwijk, A. G., Hulsker, C. C., Hunen, D. R., Ibelings, M. S., Klaase, J. M., Klicks, R., Knaapen, L., Kortekaas, R. T., Kruyt, F., Kwant, S., Lases, S. S., Lettinga, T., Loupatty, A., Matthijsen, R. A., Minnee, R. C., Mirck, B., Mitalas, L., Moes, D., Moorman, A. M., Nieuwenhuijs, V. B., Nieuwenhuizen, G. A., Nijk, P. D., Omloo, J. M., Ottenhof, A. G., Palamba, H. W., van der Peet, D. L., Pereboom, I. T., Plaisier, P. W., van der Ploeg, A. P., Raber, M. H., Reijen, M. M., Rijna, H., Rosman, C., Roumen, R. M., Scmitz, R. F., van der Velden, A. P. S., Scheurs, W. H., Sigterman, T. A., Smeets, H. J., Sonnevled, D. J., Sosef, M. N., Spoor, S. F., Stassen, L. P., van Steensel, L., Stortelder, E., Straatman, J., van Susante, H. J., de Hoog, D. E. S., Te van Scheltinga, C. R., Toorenvliet, B. R., Verbeek, P. C., Verseveld, M., Volders, J. H., Vriens, M. R., Vriens, P. W., Vrouenraets, B. C., van de wall, B. J., Wegdam, J. A., Westerduin, E., Wever, J. J., Wijfels, N. A., Wijnhoven, B. P., Winkel, T. A., van der Zee, D. C., Zeillemaker, A. M., & Zietse, C.
- Affiliations
- Tergooi (NL)
- Amsterdam University Medical Centers (NL)
- Maasstad Ziekenhuis (NL)
- ORCID
- Bolmers, Matthijs D.M.
- Bemelman, Willem A.
- Allema, J.H.
- Boekestijn, B.
- Bouwense, S.A.
- Bransen, J.
- Busch, O.R.
- Cense, H.A.
- Fassaert, L.M.
- Gerhards, M.F.
- Hamminga, J.T.
- Heikens, J.T.
- Heineman, E.
- Hulsker, C.C.
- Klaase, J.M.
- Knaapen, L.
- Kortekaas, R.T.
- Lases, S.S.
- Matthijsen, R.A.
- Minnee, R.C.
- Moorman, A.M.
- Nieuwenhuijs, V.B.
- Plaisier, P.W.
- Rosman, C.
- Roumen, R.M.
- Sigterman, T.A.
- Smeets, H.J.
- Sosef, M.N.
- Stassen, L.P.
- Straatman, J.
- Toorenvliet, B.R.
- Verseveld, M.
- Volders, J.H.
- Vriens, M.R.
- Vriens, P.W.
- Vrouenraets, B.C.
- Wegdam, J.A.
- Westerduin, E.
- Wever, J.J.
- Wijnhoven, B.P.
- Venue
- Journal of Gastrointestinal Surgery
- Publisher
- Elsevier BV
- Published
- 2020-09
- Volume
- 24
- Issue
- 9
- Pages
- 2088-2095
- ISSN
- 1091-255X (ISSN-L)
- OpenAlex
- W2968014661
- Cited by
- 18
- References
- 23
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 5 · 2020: 1
- FWCI
- 2.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Gastrointestinal Surgery (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Surgery › Intraperitoneal and Appendiceal Malignancies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
- Keywords
- acute appendicitis, complicated appendicitis, intraoperative diagnosis, histopathological evaluation, diagnostic agreement, postoperative complications, length of hospital stay, hospital readmission, reintervention
- MeSH terms
- Acute Disease, Appendectomy, Appendicitis, Appendix, Humans, Length of Stay, Laparoscopy, Postoperative Complications, Prospective Studies, Cohort Studies
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