Leaving a normal appendix at diagnostic laparoscopy carried little later risk

Design

Retrospective multicentre cohort, 4 Danish university hospitals

Population

1,145 patients with normal findings at diagnostic laparoscopy for suspected appendicitis

Primary outcome

Subsequent diagnostic laparoscopy for suspected appendicitis

Effect

3.5% (95% CI 2.0 to 4.9) after laparoscopy alone; later appendicitis 0.96%

Guidelines advise removing a macroscopically normal appendix when diagnostic laparoscopy for suspected appendicitis finds no other cause. This Danish cohort from four university hospitals, 2017 to 2021, compared 627 patients who had diagnostic laparoscopy only with 518 who had the normal appendix removed.

Over a median of about five years, 3.5% (95% CI 2.0 to 4.9) of the laparoscopy-only group had a second diagnostic laparoscopy for suspected appendicitis, and the risk of later appendicitis was 0.96%. Subsequent abdominal surgery, endoscopy and complications did not differ in the main analysis. In a sensitivity analysis, complications were more common after appendicectomy (3.7% vs 1.6%, p = 0.02), mainly bleeding and abscess.

This is retrospective and the decision to remove or leave was not random, so surgeons may have left the appendix in patients they judged lower risk. Still, it suggests the cost of preservation is small, and the case for routine removal rests more on convention than data.

• Inspect the whole pelvis and small bowel before deciding the appendix is the only candidate.
• Document the reason for leaving or removing a normal appendix.
• Tell patients who keep their appendix that later appendicitis is possible but uncommon, about 1 in 100.
• Follow local guideline until a randomised trial settles this.

Why it matters

It challenges the guideline default of removing every normal appendix once the abdomen is entered.

Don't overread it

Allocation was by surgeon choice, not randomised — lower-risk patients may have been the ones left alone.

The statistics, in plain English

A 3.5% re-laparoscopy risk over about five years means roughly 1 in 29 patients came back for another look. The complication difference appeared only in a sensitivity analysis and was small in absolute terms (about 2 percentage points).

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.