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Varying negative appendectomy rates after laparoscopic appendectomy: a systematic review and meta-analysis

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Abstract

Purpose

Appendicitis is a common cause of acute abdominal pain, and treatment with laparoscopy has become increasingly common during the past two decades. Guidelines recommend that normal appendices are removed if operated for suspected acute appendicitis. It is unclear how many patients are affected by this recommendation. The aim of this study was to estimate the rate of negative appendectomies in patients undergoing laparoscopic surgery for suspected acute appendicitis.

Methods

This study was reported following the PRISMA 2020 statement. A systematic search was conducted in PubMed and Embase for retrospective or prospective cohort studies (with n ≥ 100) including patients with suspected acute appendicitis. The primary outcome was the histopathologically confirmed negative appendectomy rate after a laparoscopic approach with a 95% confidence interval (CI). We performed subgroup analyses on geographical region, age, sex, and use of preoperative imaging or scoring systems. The risk of bias was assessed using the Newcastle-Ottawa Scale. Certainty of the evidence was assessed using GRADE.

Results

In total, 74 studies were identified, summing up to 76,688 patients. The negative appendectomy rate varied from 0% to 46% in the included studies (interquartile range 4–20%). The meta-analysis estimated the negative appendectomy rate to be 13% (95% CI 12–14%) with large variations between the individual studies. Sensitivity analyses did not change the estimate. The certainty of evidence by GRADE was moderate due to inconsistency in point estimates.

Conclusion

The overall estimated negative appendectomy rate after laparoscopic surgery was 13% with moderate certainty of evidence. The negative appendectomy rate varied greatly between studies.

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Data availability

Extracted data, bias assessment, and meta-analyses can be made available upon request to the corresponding author.

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Authors and Affiliations

  1. Centre for Perioperative Optimisation, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, DK-2730, Herlev, Denmark

    Siri R. Henriksen, Camilla Christophersen, Jacob Rosenberg & Siv Fonnes

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  1. Siri R. Henriksen
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  2. Camilla Christophersen
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  3. Jacob Rosenberg
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  4. Siv Fonnes
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Contributions

Siri Rønholdt Henriksen: conceptualisation, formal analysis, methodology, writing – original draft

Camilla Christophersen: conceptualisation, writing – review and editing

Jacob Rosenberg: conceptualisation, writing – review and editing, supervision

Siv Fonnes: conceptualisation, methodology, writing – review and editing, project administration, visualisation

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Correspondence to Siri R. Henriksen.

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The authors declare no competing interests.

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Henriksen, S.R., Christophersen, C., Rosenberg, J. et al. Varying negative appendectomy rates after laparoscopic appendectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 408, 205 (2023). https://doi.org/10.1007/s00423-023-02935-z

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