Leave or Laparoscopic Appendectomy With Normal Findings - a Regional Cohort Study
Study Details
Study Description
Brief Summary
Based on a regional cohort, this study we will try to demonstrate the superiority of routine laparoscopic appendectomy vs. leaving an intraoperative assessed normal appendix in situ in cases of normal findings at diagnostic laparoscopy. If routine laparoscopic appendectomy is not superior, we will recommend leaving the "normal" appendix in situ.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
The study is a retrospective cohort study with a superiority design. It will be carried out at the surgical departments of the four public university hospitals providing emergency surgical service to the entire population of 1,8 million in the Capital Region of Denmark.
On March 17, 2017, a new electronic health record (EHR) had been implemented at three of the hospital, while it was implemented at Copenhagen University Hospital - Bispebjerg on May 20, 2017. These dates mark the start of the inclusion period for each hospital, while the inclusion period ended April 1, 2021 for all four hospitals.
The "snap boards" covering the relevant operation rooms at the four hospitals will be systematically review. For all cases, where diagnostic laparoscopy was performed on suspicion of acute appendicitis, the EHR will be reviewed.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Diagnostic laparoscopy Diagnostic laparoscopy on suspicion of acute appendicitis with normal intraoperative findings (including mesenteric adenitis). |
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| Laparoscopic appendectomy Laparoscopic appendectomy despite normal intraoperative findings (including mesenteric adenitis) and histopathology showing a normal appendix. |
Procedure: Laparoscopic appendectomy
Laparoscopic appendectomy as performed as standard world wide. Division of the appendix with laparoscopic stapler.
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Outcome Measures
Primary Outcome Measures
- Risk of surgery on suspicion of acute appendicitis [3 years]
Laparoscopy or laparotomy after surgery on suspicion of acute appendicitis
- Risk of surgery on suspicion of acute appendicitis [5 years]
Laparoscopy or laparotomy after surgery on suspicion of acute appendicitis
Secondary Outcome Measures
- Reintervention [30 days]
Laparoscopy or laparotomy due to complications
- Postoperative complications [30 days]
Postoperative complications according to the 'Clavien-Dindo classification'
- Length of stay [30 days]
Time from index surgery to discharge
Eligibility Criteria
Criteria
Inclusion Criteria:
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Diagnostic laparoscopy with normal intraoperative findings (including mesenteric adenitis
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Laparoscopic appendectomy and a histopathological normal appendix and otherwise normal intraoperative findings (including mesenteric adenitis)
Exclusion Criteria:
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Diagnostic laparoscopy with abnormal intraoperative findings.
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Laparoscopic appendectomy and a histopathological non-normal appendix.
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Laparoscopic appendectomy and a histopathological normal appendix and abnormal intraoperative findings.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Copenhagen University Hospital - Bispebjerg | Copenhagen NV | Denmark | 2400 | |
| 2 | Copenhagen University Hospital - Herlev | Herlev | Denmark | 2730 | |
| 3 | Copenhagen University Hospital - North Zealand | Hillerød | Denmark | 3400 | |
| 4 | Copenhagen University Hospital - Hvidovre | Hvidovre | Denmark | 2650 |
Sponsors and Collaborators
- Nordsjaellands Hospital
Investigators
- Study Chair: Claus A Bertelsen, Ph.D., cabertelsen@gmail.com
Study Documents (Full-Text)
None provided.More Information
Publications
- Bakker OJ, Go PM, Puylaert JB, Kazemier G, Heij HA; Werkgroep richtlijn Diagnostiek en behandeling van acute appendicitis. [Guideline on diagnosis and treatment of acute appendicitis: imaging prior to appendectomy is recommended]. Ned Tijdschr Geneeskd. 2010;154:A303. Dutch.
- Bijnen CL, Van Den Broek WT, Bijnen AB, De Ruiter P, Gouma DJ. Implications of removing a normal appendix. Dig Surg. 2003;20(2):115-21. doi: 10.1159/000069386.
- Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M, Sugrue M, De Moya M, Gomes CA, Bhangu A, Agresta F, Moore EE, Soreide K, Griffiths E, De Castro S, Kashuk J, Kluger Y, Leppaniemi A, Ansaloni L, Andersson M, Coccolini F, Coimbra R, Gurusamy KS, Campanile FC, Biffl W, Chiara O, Moore F, Peitzman AB, Fraga GP, Costa D, Maier RV, Rizoli S, Balogh ZJ, Bendinelli C, Cirocchi R, Tonini V, Piccinini A, Tugnoli G, Jovine E, Persiani R, Biondi A, Scalea T, Stahel P, Ivatury R, Velmahos G, Andersson R. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg. 2016 Jul 18;11:34. doi: 10.1186/s13017-016-0090-5. eCollection 2016.
- Gough IR, Morris MI, Pertnikovs EI, Murray MR, Smith MB, Bestmann MS. Consequences of removal of a "normal" appendix. Med J Aust. 1983 Apr 16;1(8):370-2. doi: 10.5694/j.1326-5377.1983.tb99414.x.
- Jaunoo SS, Hale AL, Masters JP, Jaunoo SR. An international survey of opinion regarding investigation of possible appendicitis and laparoscopic management of a macroscopically normal appendix. Ann R Coll Surg Engl. 2012 Oct;94(7):476-80. doi: 10.1308/003588412X13373405385377.
- Lee M, Paavana T, Mazari F, Wilson TR. The morbidity of negative appendicectomy. Ann R Coll Surg Engl. 2014 Oct;96(7):517-20. doi: 10.1308/003588414X13946184903801.
- Sorensen AK, Bang-Nielsen A, Levic-Souzani K, Pommergaard HC, Jorgensen AB, Tolstrup MB, Rud B, Kovacevic B, Bulut O. Readmission and reoperation rates following negative diagnostic laparoscopy for clinically suspected appendicitis: The "normal" appendix should not be removed - A retrospective cohort study. Int J Surg. 2019 Apr;64:1-4. doi: 10.1016/j.ijsu.2019.02.001. Epub 2019 Feb 12. Erratum In: Int J Surg. 2020 Jul;79:154.
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