Comparison of laparoscopic appearance of appendix and resulting pathology

Objective: To report histologic discrepancies of obviously abnormal-appearing appendixes in a series of patients who had laparoscopic appendectomy. Representative samples of color pictures and histology will be presented. Method: A retrospective chart review of 65 patients who underwent appendectomy at the time of laparoscopy for treatment of associated pelvic pathology in a tertiary private care center in Atlanta, Georgia and Palo Alto, California between March 1994 and August 1999. The color photographs, operative descriptions, and histologic findings of the appendixes were compared. Results: Sixty-five patients, ages 18–67 years (mean 35.8) were identified. Pelvic pain, associated with known endometriosis (62%) and adhesions (23%), was the main indication for surgery in the majority of cases (91%). Thirty-two percent of the cases had other indications as well. Visual examinations and operative descriptions revealed abnormal appendixes in all suspected cases. Histology was positive in only 40 patients, however, and failed to identify the obvious gross pathology in 32 patients, missing mainly fibrosis and adhesions. There were no major intraoperative or postoperative complications. Two patients had suture granulomas, 1 patient, diagnosed with ovarian cancer, had mild pleural effusion which resolved without problem, and 7 patients reported symptoms of urinary tract infections. The pain was completely relieved in 35 women, decreased in 15, and persisted in 7. No follow-up information was available for 8 patients. Conclusions: Histologic examination of the appendix does not always detect the disease state identified during laparoscopy. Incorporating color photographs in the operative report seems to provide good documentation for future retrospective review. Also, it appears to be safe to perform an appendectomy when there is suspicion for involvement of the appendix.