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Should histopathological evaluation of all appendectomy specimens essential?

Yıl 2021, Cilt: 6 Sayı: 3, 123 - 126, 09.12.2021

Öz

Aim: Acute appendicitis is a surgical emergency. While fecaliths and lymphoid hyperplasia are the most
common etiological factors, some unexpected reasons can also be encountered. In order to evaluate the cause, all
appendectomy specimens are routinely sent for pathological examination in our hospital. However, some studies
question the routine sending of appendectomy specimens for pathological examination. The aim of this study is
to appreciate whether routine pathological evaluation is necessary.
Methods: The histopathological reports of 1,358 patients who underwent appendectomy between February 2019
and July 2020 in Ankara City Hospital, were retrospectively evaluated. The rate of unestimated or unexpected
findings was detected. It was evaluated whether unexpected findings were suspected clinically, radiologically
and macroscopically. In addition, the effects of unexpected results on the treatment of the patient were
identified.
Results: 811 male and 547 female were included in the study. Unexpected pathological findings were detected in
57 patients. Of the 14 patients suspected of having unexpected findings, six were confirmed pathologically, of
which one was suspected by preoperative imaging methods and five were macroscopically suspected during
surgery. While the presence of unexpected pathological findings caused additional medical treatment in two
patients and additional surgical treatment in three patients, seven patients are still being followed up in different
clinics.
Conclusion: We recommend that appendectomy specimens be routinely sent for pathological examination, as
unexpected results that may affect the patient's health, may be missed without histopathological examination. 

Kaynakça

  • 1. Unver N, Coban G, Arici DS, Buyukpinarbasili N, Gucin Z, Malya FU, et al. Unusual Histopathological Findings in Appendectomy Specimens: A Retrospective Analysis of 2047 Cases. International Journal of Surgical Pathology. 2018: 1-5.
  • 2. Duzgun AP, Moran M, Uzun S, Ozmen MM, Ozer VM, Seckin S, et al. Unusual findings in appendectomy specimens: Evaluation of 2458 cases and review of the literatüre. Indian Journal of Surgery. 2004; 66 (4): 221-26.
  • 3. Elfaedy O, Benkhadoura M, Elshaikhy A, Elgazwi K. Impact of routine histopathological examination of appendectomy specimens on patient management: a study of 4012 appendectomy specimens. Turk J Surg 2019; 35 (3): 196-201.
  • 4. Malhotra K, Bawa A. Routine Histopathological Evaluation After Appendectomy: Is It Necessary? A Systematic Review. Cureus 12(8): e9830.
  • 5. Yilmaz M, Akbulut S, Kutluturk K, Sahin N, Arabaci E, Ara C, et al. Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. orld J Gastroenterol 2013; 19(25): 4015-4022.
  • 6. Jones AE, Phillips AW, Jarvis JR, Sargen K. The value of routine histopathological examination of appendicectomy specimens. BMC Surgery 2007; 7: 17.
  • 7. Khan OA, Morhan A, Jegatheeswaran S, Jackson E, Pellikan A, et al. Routine Pathological Analysis of Appendicectomy Specimens — Is it Justified? Acta Chirurgica Belgica 2007; 107(5): 529-530.
  • 8. Akbulut S, Tas M, Sogutcu N, Arikanoglu Z, Basbug M, Utku A, et al. Unusual histopathological findings in appendectomy specimens: A retrospective analysis and literature review. World J Gastroenterol 2011; 17(15): 1961-1970.
  • 9. Matthyssens LE, Ziol M, Barrat C, Champault GG. Routine surgical pathology in general surgery. British Journal of Surgery 2006; 93: 362–368.
  • 10. Gorter RR, van Amstel P, van der Lee JH, van der Vorn P, Bakx R, Heij HA. Unexpected findings after surgery for suspected appendicitis rarely change treatment in pediatric patients; Results from a cohort study. Journal of Pediatric Surgery 2017: 1269–1272.
  • 11. Ma KW, Chia NH, Yeung HW, Cheung MT. If not appendicitis, then what else can it be? A retrospective review of 1492 appendectomies. Hong Kong Med J 2010; 16: 12-7.

Tüm apendektomi örneklerinin histopatolojik olarak değerlendirilmesi gerekli midir?

Yıl 2021, Cilt: 6 Sayı: 3, 123 - 126, 09.12.2021

Öz

Amaç: Akut apandisit cerrahi acil bir durumdur. Fekalitler ve lenfoid hiperplazi en sık karşılaşılan etiyolojik
nedenler olmakla birlikte bazı beklenmedik faktörlerle de karşılaşılmaktadır. Bunu tespit etmek amacıyla
hastanemizde rutin olarak tüm apandektomi örnekleri patolojik incelemeye gönderilmektedir. Ancak bazı
çalışmalar apandektomi örneklerinin rutin olarak patolojik incelemeye gönderilmesini sorgulamaktadırlar. Bu
çalışmanın amacı, apandektomi örnekleri için rutin patolojik incelemenin gerekli olup olmadığını
değerlendirmektir.
Yöntemler: Ankara Şehir Hastanesinde Şubat 2019-Temmuz 2020 tarihleri arasında apandektomi yapılan 1358
hastanın histopatolojik raporları retrospektif olarak değerlendirildi. Tahmin edilemeyen ya da beklenmedik
histopatolojik sonuçların oranı, klinik, radyolojik ve makroskopik olarak şüphelenilip şüphelenilmediği ve
ayrıca hastanın tedavisine etkileri tespit edilerek değerlendirme yapıldı.
Bulgular: Çalışmaya 811 erkek ve 547 kadın hasta dahil edildi. 57 hastada beklenmeyen patolojik sonuçlar tespit
edildi. Beklenmedik sonuç çıkabileceğinden şüphelenilen 14 hastanın 6'sı patolojik olarak doğrulandı.
Bunlardan 1'inden ameliyat öncesi görüntüleme yöntemleriyle ve 5'inden ameliyat sırasında makroskopik olarak
şüphelenildi. Beklenmedik patolojik bulguların varlığı 2 hastada ilave medikal tedaviye, 3 hastada ise ek cerrahi
tedaviye neden olurken, 7 hastanın farklı kliniklerde takibi halen daha devam etmektedir.
Sonuç: Histopatolojik inceleme yapılmadan hastanın sağlığını etkileyebilecek beklenmedik sonuçların gözden
kaçabilme ihtimalinden dolayı, apandektomi örneklerinin rutin olarak patolojik incelemeye gönderilmesini
öneriyoruz.

Kaynakça

  • 1. Unver N, Coban G, Arici DS, Buyukpinarbasili N, Gucin Z, Malya FU, et al. Unusual Histopathological Findings in Appendectomy Specimens: A Retrospective Analysis of 2047 Cases. International Journal of Surgical Pathology. 2018: 1-5.
  • 2. Duzgun AP, Moran M, Uzun S, Ozmen MM, Ozer VM, Seckin S, et al. Unusual findings in appendectomy specimens: Evaluation of 2458 cases and review of the literatüre. Indian Journal of Surgery. 2004; 66 (4): 221-26.
  • 3. Elfaedy O, Benkhadoura M, Elshaikhy A, Elgazwi K. Impact of routine histopathological examination of appendectomy specimens on patient management: a study of 4012 appendectomy specimens. Turk J Surg 2019; 35 (3): 196-201.
  • 4. Malhotra K, Bawa A. Routine Histopathological Evaluation After Appendectomy: Is It Necessary? A Systematic Review. Cureus 12(8): e9830.
  • 5. Yilmaz M, Akbulut S, Kutluturk K, Sahin N, Arabaci E, Ara C, et al. Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. orld J Gastroenterol 2013; 19(25): 4015-4022.
  • 6. Jones AE, Phillips AW, Jarvis JR, Sargen K. The value of routine histopathological examination of appendicectomy specimens. BMC Surgery 2007; 7: 17.
  • 7. Khan OA, Morhan A, Jegatheeswaran S, Jackson E, Pellikan A, et al. Routine Pathological Analysis of Appendicectomy Specimens — Is it Justified? Acta Chirurgica Belgica 2007; 107(5): 529-530.
  • 8. Akbulut S, Tas M, Sogutcu N, Arikanoglu Z, Basbug M, Utku A, et al. Unusual histopathological findings in appendectomy specimens: A retrospective analysis and literature review. World J Gastroenterol 2011; 17(15): 1961-1970.
  • 9. Matthyssens LE, Ziol M, Barrat C, Champault GG. Routine surgical pathology in general surgery. British Journal of Surgery 2006; 93: 362–368.
  • 10. Gorter RR, van Amstel P, van der Lee JH, van der Vorn P, Bakx R, Heij HA. Unexpected findings after surgery for suspected appendicitis rarely change treatment in pediatric patients; Results from a cohort study. Journal of Pediatric Surgery 2017: 1269–1272.
  • 11. Ma KW, Chia NH, Yeung HW, Cheung MT. If not appendicitis, then what else can it be? A retrospective review of 1492 appendectomies. Hong Kong Med J 2010; 16: 12-7.
Toplam 11 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm Orjinal Makale
Yazarlar

Mustafa Dönmez 0000-0003-2598-7019

Mustafa Ömer Yazıcıoğlu 0000-0001-6150-0226

Yayımlanma Tarihi 9 Aralık 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 6 Sayı: 3

Kaynak Göster

Vancouver Dönmez M, Yazıcıoğlu MÖ. Should histopathological evaluation of all appendectomy specimens essential?. Arch Clin Exp Med. 2021;6(3):123-6.