Page 12 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Do We Still Encounter Non-appendicitis Pathologies during

Laparoscopic Appendectomy?

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Yasser A Orban , Mohammed Algazar , Ahmed Farag , Tamer R Elalfy 4
AbstrAct
Aims and objectives: Acute appendicitis is the most common surgical disease with a lifetime risk of 7–8%. Numerous studies have shown
many benefits of laparoscopic appendectomy over open appendectomies, such as better visualization and identification of other abdominal
pathologies that can mimic acute appendicitis. Herein, we illustrated the current incidence of non-appendicitis pathologies during laparoscopic
appendectomies in our hospital.
Materials and methods: A retrospective study was carried out involving patients operated for acute appendicitis laparoscopically at the Surgical
Emergency Unit, Zagazig University Hospitals, Egypt, during the period from March 2017 to December 2019. The diagnosis of acute appendicitis
was based on clinical examination, laboratory findings, and ultrasonography. We drew out the patients’ demographic data, duration of surgery,
and surgical procedure reports.
Results: One hundred forty-five patients presented clinically, and confirmed by laboratory and ultrasonography with the diagnosis of acute
appendicitis. Eighty-nine were males, 56 were females. The median operative time was 56.5 minutes. Eight cases (5.5%) showed a pathology
other than acute appendicitis, including gynecological pathologies, Mickel’s diverticulitis, inflamed sigmoid appendices epiploica, low-grade
appendiceal mucinous neoplasm, and inflamed cecal diverticulum.
Conclusion: Diagnosis of acute appendicitis is challenging up to date. We faced many conditions mimicking acute appendicitis during surgical
intervention.
Keywords: Appendectomy, Appendicitis, Diverticulitis.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1432

IntroductIon 1–4 Department of Surgery, Zagazig University, Zagazig, Sharkia,
Acute appendicitis is the most common surgical disease with a Egypt
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lifetime risk of 7–8%. In 1977, Hans de Kok performed the first Corresponding Author: Mohammed Algazar, Department of Surgery,
laparoscopic-assisted appendectomy, which was not popularized Zagazig University, Zagazig, Sharkia, Egypt, Phone: +20 01028913029,
until Semm published the first laparoscopic appendectomy in e-mail: drmohammedezzat4@gmail.com
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1983. Numerous studies have shown many benefits of laparoscopic How to cite this article: Orban YA, Algazar M, Farag A, et al. Do We
appendectomy over open appendectomies, such as better Still Encounter Non-appendicitis Pathologies during Laparoscopic
visualization and identification of other abdominal pathologies Appendectomy? World J Lap Surg 2021;14(1):10–14.
that can mimic acute appendicitis. 3 Source of support: Nil

The current incidence of incidental non-appendicitis Conflict of interest: None
histopathological findings during appendectomy is 3.9%,
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whether open or minimally invasive appendectomies. Herein, we
illustrated the incidence of non-appendicitis pathologies during pathology had been encountered, it was dealt with laparoscopically.
a laparoscopic appendectomy in the Surgical Emergency Unit, Appendectomy was done on all patients, even if there was another
Zagazig University Hospitals, Egypt. intra-abdominal pathology.
A case of intraoperative suspected cecal diverticulitis was
MAterIAls And Methods treated conservatively postoperatively without any further surgical
intervention.
A retrospective analysis of patients who underwent laparoscopic Histopathology of the resected biopsies (appendix and other
appendectomies from March 2017 to December 2019 at the Surgical pathologies) was done for all cases. A histopathological report
Emergency Unit, Zagazig University Hospitals, Egypt. Pathologies of a removed appendix revealed low-grade mucinous neoplasm
other than acute inflammation of the appendix were recorded. We with free margins and no infiltration to the basement membrane
extracted the patients’ demographic data, duration of surgery, and (carcinoma in situ); the patient was referred to the medical oncology
surgical procedure reports. department that recommended only follow-up of the patient.
All patients had a preoperative diagnosis of acute appendicitis
depending on the clinical picture, laboratory investigations
(complete blood count for leukocytosis and neutrophilia), and results
ultrasonography. One hundred and forty-five patients presented clinically. They
At the laparoscopic appendectomy, the abdominal cavity was were diagnosed with acute appendicitis after laboratory tests
laparoscopically explored for other surgical pathologies. If any other and ultrasonography. Eighty-nine patients (61.38%) were males,

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