Leaving a normal appendix at diagnostic laparoscopy rarely led to a second operation

Design

Retrospective multicentre cohort study

Population

1,145 patients with a normal appendix at diagnostic laparoscopy in four Danish hospitals

Primary outcome

Repeat diagnostic laparoscopy for suspected appendicitis

Effect

3.5% (95% CI 2.0 to 4.9) after appendix left in place; later appendicitis 0.96%

A retrospective cohort from four Danish university hospitals (World Journal of Surgery, 19 September 2026) followed patients over two years old who had diagnostic laparoscopy for suspected appendicitis between 2017 and 2021 and were found to have a normal-looking appendix. 627 had the appendix left in place; 518 had it removed anyway. Median follow-up was more than five years.

Among those whose appendix was left, 3.5% had a second diagnostic laparoscopy for suspected appendicitis, at a median of 1.7 years, and the subsequent risk of appendicitis was 0.96%. The main analyses found no difference in later abdominal surgery, endoscopy or complications. In a sensitivity analysis, surgical complications were more frequent after removal (3.7% vs 1.6%), driven by bleeding and abscess.

Many guidelines still advise removing a normal appendix once the abdomen is open, partly to avoid diagnostic confusion later. This cohort suggests the cost of leaving it is small. It is observational, though, and surgeons who removed the appendix may have been more suspicious of it.

• When the appendix looks normal and another cause is found, leaving it in is a defensible choice.
• Record clearly in the notes and discharge letter that the appendix was left in situ.
• Tell the patient, so a future clinician is not misled by a laparoscopy scar.
• Follow your unit's policy; this cohort does not overturn guidance on its own.

Why it matters

It questions a reflex removal that adds operative risk to patients who turn out not to have appendicitis.

Don't overread it

This was a retrospective cohort, and the extra complications after removal appeared only in a sensitivity analysis.

The statistics, in plain English

A 3.5% repeat laparoscopy rate with a 95% confidence interval of 2.0% to 4.9% means roughly one in thirty patients came back for a second look. The complication difference reached significance only when the analysis included patients with incidental findings, which makes it less secure than a primary result.

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