DIAGNOSTIC INDEXES FINDINGS IN EARLY STAGES OF APPENDICITIS (DIFESA STUDY): A REANALYSIS FROM THE POSAW STUDY DATABASE


Diagnostic Indexes Findings in Early Stages of Appendicitis (DIFESA Study): a reanalysis from the POSAW study database


Carlos Augusto Gomes1*, Luis Pordeus Shafee1, Ana Luíza de Castro Carvalho1, Lucas Machado de Souza Vicente2, Felipe Couto Gomes2, Mauro Podda3, Belinda de Simone4, Massimo Sartelli5, Fausto Catena6

1Department of Surgery, Hospital Universitário, Universidade Federal de Juiz de Fora. MG, Brasil. 2Hospital Universitário Terezinha de jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de FORA, MG, Brasil. 3Department of Surgical Science University of Cagliari (Italy). 4Unit of Metabolic, Digestive and Emergency Surgery, Centre Hospitalier Intercommunal de Poissy et Saint Germain en Laye, France. 5General and Emergency Surgery, Macerata Hospital, Macerata, Italy. 6Bufalini Hospital Cesena Italy.


Purpose: The resection of a normal-looking appendix during laparoscopic appendicectomy (LA) remains a dilemma. The optimal approach requires reliable macroscopic judgment by the surgeons. The aim of this study is to assess the surgeon’s ability to laparoscopically diagnose acute appendicitis (AA) in its initial uncomplicated grades.

Method: Subgroup analysis from the POSAW study, 2016. Patients diagnosed with initial grades of AA (0 – 1) who underwent LA were included (n=718). The median age was 29.4 years, and 52% were female. The accuracy of the macroscopic intraoperative diagnosis was assessed with the histopathological examination of the resected specimens, and the agreement between the surgeon’s and the pathologist’s judgment was established.

Results: Of the 79 appendices classified intraoperatively as normal-looking, 18 (22.8%) had some inflammation degree. Of the 639 appendices classified intraoperatively as inflamed, 101 (15.8%) were normal. The intraoperative surgeon’s judgment had an accuracy of 83.4% and a moderate to low agreement (Kappa 0.42). The sensitivity and specificity values were 96.8% and 37.7%, and the positive and negative predictive values were 84.2% and 77.2%, respectively.

Conclusion: The surgeon’s intraoperative diagnosis of uncomplicated AA’s initial grades is not sufficiently accurate to establish good reliability for appendicectomy. The surgeon overestimates the presence of appendicular inflammation.


Keywords: Appendicitis; Appendectomy; Laparoscopy, Diagnosis.

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Carlos Augusto Gomes, Luis Pordeus Shafee, Ana Luíza de Castro Carvalho, Lucas Machado de Souza Vicente, Felipe Couto Gomes, Mauro Podda, Belinda de Simone Massimo Sartelli, Fausto Catena. Diagnostic Indexes Findings in Early Stages of Appendicitis (DIFESA Study): a reanalysis from the POSAW study database. American Journal of Surgical Research and Reviews, 2021, 4:35. DOI:10.28933/ajsrr-2021-10-0305


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