Morphopathological Findings In Negative Appendectomies In Children

Background: The removal of a macroscopically and/or histologically normal appendix during surgical interventions performed on the basis of a clinical suspicion of acute appendicitis is referred to as negative appendectomy, although there is no consensus regarding this definition. The aim of the study was to evaluate the rate of negative laparoscopic appendectomy in children with a clinical suspicion of acute appendicitis and to analyze the correlation between intraoperative macroscopic features and the histopathological findings of the appendiceal specimens. Materials and Methods: A retrospective study was conducted on 650 patients aged 3–18 years who underwent open appendectomy and 250 children who underwent emergency laparoscopic appendectomy between 2018 and 2025. Negative appendectomy was defined as the absence of postoperative histopathological evidence of acute appendicitis, which was defined as the presence of transmural acute inflammation of the appendix. Results: Initially, 84 patients were classified as having undergone a negative open appendectomy, yielding a rate of 12.92%. Of the total number of patients with negative open appendectomy, 21 cases showed no evident histopathological inflammatory changes in the appendix on histological examination; in these cases, alternative diagnoses were identified, such as ovarian apoplexy (4 cases), endometriosis (1 case), polycystic ovary syndrome (1 case), intraluminal parasites (6 cases), and regional mesadenitis without signs of pelvioperitonitis (9 cases). In 63 patients, various histological changes were documented in the removed appendix, including submucosal lymphoid follicular hyperplasia without significant signs of mucosal inflammation and without involvement of the muscular layers (37 cases), chronic appendicitis (10 cases), ganglioneuropathies (5 cases), intraluminal coproliths (6 cases), parasitic infection associated with submucosal lymphoid follicular hyperplasia (3 cases), well-differentiated carcinoid tumor (1 case), and malignant non-Hodgkin lymphoma (1 case). Of the total 250 laparoscopic appendectomies, the negative appendectomy rate was 17 cases (6.8%). Histological examination revealed chronic appendicitis with obliteration of the appendiceal lumen and subatrophic hyperplastic or atrophic changes (8 cases), the presence of coproliths (5 cases), lymphoid follicular hyperplasia in 2 cases, and in 2 cases lymphoid follicular hyperplasia associated with the intraluminal presence of helminths. Conclusions: Laparoscopic appendectomy represents a feasible option for reducing the incidence of negative appendectomy in children. The term “negative appendectomy” should be redefined in pediatric surgery based on the implementation of new strategies aimed at improving diagnostic accuracy, including videolaparoscopy, which - together with a high index of suspicion for certain misleading diagnoses - may contribute to reducing the risk of unnecessary surgical interventions and avoiding negative appendectomy in children. Histopathological examination of appendiceal resection specimens in children should be considered mandatory and justified even when the appendix appears macroscopically normal, given the potential for identifying unusual histopathological findings in negative appendectomy specimens from children with a clinical suspicion of acute appendicitis.