Is it Necessary to do Colonoscopy after Appendicectomy in Patients Over the Age of 50 Years? (2019)

Type of publication:
Conference abstract

Author(s):
*Chakrabarty A.; *Vardhrajan V.; *Cheetham M

Citation:
British Journal of Surgery; Sep 2019; vol. 106 S5; p. 70

Abstract:
Aim: In the United Kingdom 1 in 13 people are affected by appendicitis. The commonest age group is between
10 to 20 years. Appendicitis is relatively uncommon in adults over 50 years. There is a belief that appendicitis
may be precipitated or mimicked by colorectal cancer and hence some surgeons recommend that patients over the age of 50 should undergo a post-operative colonoscopy.
Method(s): We identified patients over the age of 50 years who had appendicectomies in our hospital between
2013 and 2017 usingHES data. Detailed data was collected for all the patients from radiology and endoscopy
data bases. We calculated the cost of post-operative colonoscopy to the health system using PBR tariff.
Result(s): 396 patients aged over 50 underwent emergency appendicectomy during the study period. Of these
284 (72%) had had pre-operative C T scans. 88 (22%) out of the 396 patients underwent a colonoscopy within 3 months of their appendicectomy. Of these 88 patients, 62 had pre-operative CT scans. No cancers were found on post-operative colonoscopy. The cost of performing post-operative colonoscopy in this cohort was 35, 464.
Conclusion(s): In an era of liberal preoperative CT scanning for patients over 50 with right iliac fossa pain, it is
not necessary to perform a colonoscopy after appendicectomy. We recommend that for patients who have a
preoperative CT scan, a post-operative colonoscopy is only needed if there are specific imaging abnormalities.

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Diagnostic laparoscopy in acute right iliac fossa (RIF) pain to take the appendix or to leave it in? (2015)

Type of publication:
Conference abstract

Author(s):
*Sukha A., *Packer H., *Taylor M., *Goodyear S.

Citation:
Surgical Endoscopy and Other Interventional Techniques, April 2015, vol./is. 29/(S309-S310)

Abstract:
Aims Laparoscopy is used to both investigate acute RIF pain and treat the findings of an inflamed appendix. This study investigates the histology of appendixes where the clinical diagnosis was unclear on presentation and the investigative imaging was inconclusive. Methods Retrospective data collection between January – June 2014 of all appendectomies. Data was collected from Theatre logbooks and the Pathology and PACS computer systems, and analysed in Microsoft Excel. Results 50 patients had an undiagnosed cause of RIF pain. 15% (n = 34) had an USS and 7% (n = 16) had a CT. 58% (n = 29) of scans were reported as negative/inconclusive for appendicitis. All 29 patients had a DL and appendicectomy and 45% (n = 13) were histologically reported as appendicitis. There was 3% (n = 1) associated morbidity and 0% mortality. Conclusion The appendix should be removed when faced with a diagnostic uncertainty and no other pathology is found. The advancement of laparoscopic skills and training has led to low morbidity and mortality as supported by this study. We conclude it is safer to remove the appendix than to leave it in. Key statement The presentation of an acute right iliac fossa pain can sometimes be clinically difficult to diagnose. When investigations are normal or inconclusive and symptoms persist the advancement of laparoscopic surgery allows us to perform diagnostic laparoscopy. When there is no obvious pathology found the appendix should still be removed.

Is the negativity rate of laparoscopic appendicectomies on the increase? (2015)

Type of publication:
Conference abstract

Author(s):
*Sukha A., *Packer H., *Taylor M., *Goodyear S.

Citation:
Surgical Endoscopy and Other Interventional Techniques, April 2015, vol./is. 29/(S313)

Abstract:
Aims: This study investigates the histological appearance of appendixes from laparoscopic and open appendicectomies. We propose that the negativity rate of laparoscopic appendicectomies is when compared to an open appendicectomy due to the advancements in laparoscopic equipment and surgeon skills. Methods Retrospective data collection of all appendicectomies between January – June 2014. Data was collected from Theatre logbooks and the Pathology and PACS computer systems, and analysed in Microsoft Excel. Results 226 appendectomies were performed on the emergency-operating list. 174 (77%) had a laparoscopic appendicectomy and 52(23%) had an open procedure. The negative appendix rate on histology was significantly higher in the laparoscopic group (28.2%, n = 49) versus the open group (11.5%, n = 6) p = 0.05. There was a 2% (n = 5) associated morbidity and 0% mortality. Conclusion Laparoscopic surgery is considered to be a minimally invasive surgical procedure with low associated risks. The appendix is removed when inflamed and often in right iliac fossa pain when no other pathology is found. Our study shows that laparoscopy may be overused resulting in higher than expected negativity rates. Key statement Laparoscopic surgery is fast becoming the preferred operative procedure for the suspected appendicitis diagnostic tool in the unclear presentation of right iliac fossa pain. The minimally invasive procedure is considered to be a safe procedure perhaps resulting in its overuse. We investigate the negativity rate in laparoscopic verses open appendicectomy.