Safety of incidental appendectomy. Prospective evaluation of nonsurgical versus surgical management of appendiceal mass. [Technique and significance of stump management for outcome of laparoscopic appendectomy]. Laparoscopic versus open appendectomy: prospective randomized trial. Laparoscopic Appendectomy Using Endoloops: A Prospective, Randomized Clinical Trial Wound sepsis after cholecystectomy. Influence of incidental appendectomy. Impact of adjunctive testing on the diagnosis and clinical course of patients with acute appendicitis. Laparoscopic versus open surgical exploration in premenopausal women with suspected acute appendicitis. Laparoscopic versus Open Appendectomy: Prospective Randomized Trial Comparison of Intracorporeal Knot-tying Suture (Polyglactin) and Titanium Endoclips in Laparoscopic Appendiceal Stump Closure: A Prospective Randomized Study Initial laparoscopic appendectomy versus initial nonoperative management and interval appendectomy for perforated appendicitis with abscess: a prospective, randomized trial. Laparoscopic versus open appendicectomy for complicated appendicitis: A prospective study Improving Outcomes After Laparoscopic Appendectomy: A Population-Based, 12-year Trend Analysis of 7446 Patients Outpatient laparoscopic appendectomy should be the standard of care for uncomplicated appendicitis 
Open and laparoscopic appendectomy are equally safe and acceptable in children
 Laparoscopic appendectomy in the treatment of acute appendicitis. Diagnostic laparoscopy in 1043 patients with suspected acute appendicitis.
Reports in the surgical literature are conflicting as to whether appendectomy " in passing " during laparotomy for trauma or for some other disease state does or does not significantly increase patient morbidity or mortality . A chart survey of all appendectomies ( 342 for acute appendicitis and 146 as incidental procedures ) performed on the trauma service of Grady Memorial Hospital over a 40 month period appeared to indicate that the wound infection rate ( 6.8 percent ) was the same as that for acute simple or suppurative appendicitis ( 6.7 percent ) , whereas the intraabdominal sepsis rate ( 17.5 percent ) paralleled that for more advanced gangrenous or perforative appendicitis ( 18.6 percent ) . Since the validity of a retrospective review is always open to question , a prospect i ve , r and omized trial was carried out only on patients with a negative abdominal exploration for trauma over a 22 month interval at the same trauma service . An odd second from the last digit hospital number dictated appendectomy , provided the appendix was readily accessible ; an even digit in the same locus dictated retention of the appendix . In no patient did intraperitoneal sepsis develop , regardless of the procedure chosen . Wound infection rates were 1.8 percent for appendectomy ( 1 of 56 ) , if local anatomic considerations precluded an easy appendectomy ( 0 of 45 ) , and 3.6 percent for the control subjects without appendectomy ( 3 of 83 ) . There were no deaths . These data cast considerable doubt on the reliability of retrospective review s and support the generally accepted dictum that incidental appendectomy , especially in the trauma patient , can be a relatively innocuous procedure PURPOSE Prospect i ve evaluation was undertaken of surgical findings , complications , morbidity , and hospital stay between initial nonsurgical management versus early surgical intervention of an appendicular mass . METHODS A prospect i ve , nonr and omized study was conducted of 82 consecutive patients ( mean age , 6.9 + /- 3.3 years ) presenting with an appendicular mass over a 5-year period . They were categorized as group 1 , 58.5 % ( 48 of 82 ) nonsurgically managed and an interval appendectomy performed at a mean period of 8.6 + /- 4.6 weeks and group 2 , 41.5 % ( 34 of 82 ) appendectomy at presentation . RESULTS An appendix was identified in all 82 patients in both groups at operation . In-group 1 , recurrent episodes of abdominal pain necessitated interval appendectomy in 39.6 % ( 19 of 48 ) patients at a mean 4.3 + /- 0.8 versus 11.5 + /- 3.7 weeks in 60.4 % ( 29 of 48 ) who underwent scheduled interval appendectomy .  Periappendiceal abscesses present at interval appendectomy in group 1 was ( 38 of 48 ) 79.2 % versus 100 % ( 34 of 34 ) at appendectomy in group 2 . Adhesions at interval appendectomy  in group 1 was 81.3 % ( 39 of 48 ) versus 100 % ( 34 of 34 ) at appendectomy in group 2 . In-group 1 , superficial wound infection was observed in 0 versus 4 wound infections in group 2 . Overall morbidity rate between group 1 and group 2 was statistically significant ( P < .05 ) . Total mean hospital stay in group 1 was 13.2 + /- 1.5 versus 4.8 + /- 0.4 days in group 2 . Of the 48-interval appendectomy specimens , 37 of 48 ( 77 % ) appendices had a patent lumen , and 11 of 48 ( 23 % ) showed fibrosis and obliteration of appendicular lumen . There was no correlation ( r = 0.22 ) between the histopathologic findings and the interval between abscess treatment and interval appendectomy . CONCLUSIONS Early surgical intervention was beneficial over nonoperative management in this cohort of patients . Interval appendectomy is recommended after nonsurgical management of an appendicular mass We compared 140 appendectomies in a prospect i ve study with regard to length of operation , stay in hospital and intra- and postoperative complications . We operated by four methods and made up four groups , 35 patients in each : ( 1 ) application of RODER-loop and manual stump-sinking ; ( 2 ) application of RODER-loop without manual stump-sinking ; ( 3 ) application of Endo-GIA ; ( 4 ) conventional appendectomy according to McBurney  .  Intraoperative complications occurred mainly in laparoscopic appendectomy , while disturbances of wound-healing were observed mainly in conventional appendectomy . The analysis of postoperative complications in laparoscopic appendectomy showed the most complications in the second group ( RODER-loop without stump-sinking ) , while using the Endo-GIA involved only a little risk . In a clear situs the laparoscopic appendectomy with the RODER-loop with manual stump-sinking is recommended ; in cases with a difficult preparation or advanced appendicitis the application of the Endo-GIA is a safe technique with the best results Although classic open surgery is simple , expeditious , and effective , it has some drawbacks , including wound sepsis , delayed recovery , operative difficulties , and possibility of unnecessary appendectomies for false appendicitis . The aim of this study was to assess the applicability and safety of laparoscopic appendectomy ( LA ) in a prospect ively r and omized trial . Seventy nonselective patients with suspected appendicitis were r and omized to laparoscopic ( n = 35 , 17 male ) or open appendectomy ( n = 35 , 15 male ) and operated on an emergency basis . Operative findings , operating time , postoperative complications , and length of hospital stay were compared . We found that LA is associated with a shorter hospital stay , fewer postoperative complications , and better diagnostic accuracy , and it is recommended as the procedure of choice for the diagnosis and management of acute appendicitis Background Inadequate closure of the appendix stump can lead to abscess formation or peritonitis . This prospect i ve r and omized clinical trial was performed to evaluate the number of endoloops needed in  laparoscopic appendectomy .  Methods A total of 208 patients were r and omized in two groups : 109 in group 1 using one and 99 in group 2 using two proximal endoloops . The groups were compared in terms of intra- and postoperative complications . Results Postoperative complications were found in five patients ( 4.6 % ) in group 1 , consisting of intraabdominal abscesses ( three patients ) , pulmonary embolism ( one patient ) , and persisting port-site pain ( one patient ) . In group 2 , postoperative complications were found in five patients ( 5.1 % ) , consisting of intraabdominal abscesses ( four patients ) and prolonged percutaneous drainage ( one patient ) . There was no significant difference between the two groups . Discussion In acute appendicitis , a minimal inflamed appendix base can be safely divided using one endoloop We undertook a prospect i ve study of the effect of incidental appendectomy on the safety of cholecystectomy  in patients under the age of 50 years . One hundred twenty patients were r and omized to have either cholecystectomy alone or cholecystectomy and appendectomy .  All patients received preoperative antibiotic cover . Both groups were well matched for age , sex , obesity , and length of hospital stay . Twelve patients were withdrawn from the trial .  Wound infections occurred in three of the 56 patients in the cholecystectomy group ( 5.3 % ) and in two of the 52 patients in the cholecystectomy plus appendectomy group ( 3.8 % ) . Incidental appendectomy is a safe addition to elective cholecystectomy The diagnosis of acute appendicitis is usually made from the history and physical examination . Recently , abdominal ultrasonography ( US ) , laparoscopy , computerized tomography ( CT ) , and barium enema ( BE ) have been used in the preoperative evaluation of patients with presumed appendicitis in order to improve the diagnostic accuracy . However , the usefulness of these tests in verifying the diagnosis of appendicitis has not been established . We review ed the medical records of 203 patients who underwent appendectomy . One hundred patients were surgically treated before 1984 ( group I ) and 103 patients underwent surgery after 1988 ( group II ) . Patients in group II were more likely to have preoperative US , laparoscopy , CT , or BE  ( 24 in group II versus 3 in group I , p < 0.05 ) . When groups I and II were compared , the rates of perforation ( 27 % versus 20 % ) , normal appendectomy ( 8 % versus 11 % ) , and the interval between admission and operation ( 12.2 hours versus 10.7 hours ) and length of hospitalization ( 5.0 days versus 5.1 days ) were not significantly different . We concluded that although adjunctive testing may be beneficial in selected patients , its routine use in patients suspected of having appendicitis can not be advocated at present OBJECTIVES To assess the utility of laparoscopic versus conventional surgical exploration in premenopausal women with suspected acute appendicitis . METHOD Female patients aged 15 - 45 years in whom an independent decision to undertake surgical exploration had been made , were r and omised to laparoscopic or open procedures .  Comparison of patient groups was conducted on an intention-to-treat basis . RESULTS Eighteen patients underwent laparoscopic exploration  , with 1 procedure requiring conversion to lower midline laparotomy . Open surgical exploration was performed primarily in 16 patients .  Postoperative complications ( 3 patients versus 1 patient ) and diagnostic errors ( 5 patients versus 1 patient ) were more frequent in patients undergoing open surgical procedures . Laparoscopic procedures tended to be of longer duration than open operations , but were generally associated with slightly more favourable indices of postoperative recovery ( analgesic requirement , postoperative hospitalisation , return to normal activity , return to work ) . In patients found not to have acute appendicitis , the difference in mean postoperative hospitalisation following laparoscopic intervention ( 2.6 days ) and conventional surgery ( 3.4 days ) approached statistical significance ( p < 0.1 ) . CONCLUSIONS Laparoscopy may carry some diagnostic advantage over open surgery in premenopausal women with suspected acute appendicitis . Patients found not to have acute appendicitis have a marginally shorter period of hospitalisation after laparoscopic intervention . The outcome following laparoscopic appendicectomy for confirmed acute appendicitis is at least equivalent to that achieved with conventional appendicectomy . Laparoscopic exploration is an acceptable option in premonopausal women requiring surgery for suspected acute appendicitis Abstract . A prospect i ve r and omized trial comparing laparoscopic appendectomy with open appendectomy in patients with a diagnosis of acute appendicitis was conducted between October 1992 and April 1994 . Of the 158 patients r and omized , 7 patients were excluded because of protocol violations ( conversion to laparotomy in 4 , appendix not removed in 3 ) . The 151 patients r and omized to either a laparoscopic ( n = 79 ) or an open appendectomy ( n = 72 ) showed no difference in sex , age , American Society of Anesthesiology ( ASA ) rating , or previous abdominal surgery . The histologic classification of normal , catarrhal , inflamed , suppurative , and gangrenous appendicitis was not different between the two groups . Conversion from laparoscopic to open appendectomy was necessary in seven patients ( 9 % ) who had advanced forms of appendiceal inflammation . When compared to open appendectomy the laparoscopic group had a longer median operating time ( 63 minutes versus 40 minutes ) , fewer wound infections ( 2 % versus 11 % ) , less requirement for narcotic analgesia , and an earlier return to normal activity ( median 7 days versus 14 days ) . There was no difference in morbidity , and both groups had a median time to discharge of 3 days . Laparoscopic appendectomy is as safe as open appendectomy ; and despite the longer operating time , the advantages such as fewer wound infections and earlier return to normal activity make it a worthwhile alternative for patients with a clinical diagnosis of acute appendicitis Background : Laparoscopic appendectomy is a well-described surgical technique . However , concerns still exist regarding whether the closure of the appendiceal stump should be done with a clip , an endoloop , staples , or other techniques . Therefore , several modifications to the original technique with new material s have been introduced for appendiceal stump closure . The aim of this study was to compare intracorporeal ( polyglactin ) knot-tying suture with titanium endoclips in appendiceal stump closure during laparoscopic appendectomy . Methods : The study was carried out as a prospect i ve r and omized clinical trial between April 2010 and February 2011 . Patients with a presentation of appendicitis were included into the study . Two groups were defined— patients with the titanium endoclip and patients with the knot-tying ( polyglactin ) suture . The results in terms of operating time , complication rates , and hospital stay were analyzed . Results : Sixty-one patients who underwent laparoscopic appendectomy were enrolled in the titanium endoclip group ( n=30 ) or the knot-tying ( polyglactin ) suture group ( n=31 ) . No statistically significant differences were detected between the groups in terms of the distribution of age , sex percentage , appendix localization , and histopathologic diagnosis ( P>0.05 ) . One patient required a second operation on postoperative day 10 because of intraperitoneal abscess . The mean operative time for the endoclip group ( 41.27±12.2 min ) was shorter than that for the knot-tying group ( 62.81±15.4 min ) ( P=0.001 ) . No statistically significant differences were detected between the groups in terms of hospital stay , follow-up time , and preoperative and postoperative complications ( P>0.05 ) . Conclusions : In laparoscopic appendectomy , using a titanium endoclip for optimizing and controlling the appendiceal stump closure is safe and is associated with shorter operation time . This also simplifies the procedure , so it can be a useful alternative to intracorporeal knot-tying for appendiceal stump closure INTRODUCTION Perforated appendicitis is a common condition in children , which , in a small number of patients , may be complicated by a well-formed abscess . Initial nonoperative management with percutaneous drainage/aspiration of the abscess followed by intravenous antibiotics usually allows for an uneventful interval appendectomy . Although this strategy has become well accepted , there are no published data comparing initial nonoperative management ( drainage/interval appendectomy ) to appendectomy upon presentation with an abscess . Therefore , we conducted a r and omized trial comparing these 2 management strategies . METHODS After internal review board approval ( # 06 11 - 164 ) , children who presented with a well-defined abdominal abscess by computed tomographic imaging were r and omized on admission to laparoscopic appendectomy or intravenous antibiotics with percutaneous drainage of the abscess  ( when possible ) , followed by interval laparoscopic appendectomy approximately 10 weeks later . This was a pilot study with a sample size of 40 , which was based on our recent volume of patients presenting with appendicitis and abscess . RESULTS On presentation , there were no differences between the 2 groups regarding age , weight , body mass index , sex distribution , temperature , leukocyte count , number of abscesses , or greatest 2-dimensional area of abscess in the axial view . Regarding outcomes , there were no differences in length of total hospitalization , recurrent abscess rates , or overall charges . There was a trend toward a longer operating time in patients undergoing initial appendectomy ( 61 minutes versus 42 minutes mean , P = .06 ) . CONCLUSIONS Although initial laparoscopic appendectomy trends toward a requiring longer operative time , there seems to be no advantages between these strategies in terms of total hospitalization , recurrent abscess rate , or total charges Aims : The purpose of this study was to compare open versus laparoscopic appendicectomy ( LA ) in complicated appendicitis . Material s and Methods : We prospect ively analyzed all children over a 2-year period who underwent appendicectomy in a single institution and found 30 cases of complicated appendicitis diagnosed on the table and confirmed by histopathology . These children were allocated r and omly into Group 1 if they had LA and Group 2 if they had open appendicectomy ( OA ) , solely based on surgeon assessment . The parameters assessed were duration of symptoms before surgery , use of postoperative parenteral analgesia , timing of initiation of feeds after surgery , postoperative complications and duration of postoperative stay . Results : Of the 30 patients with complicated appendicitis , 12 patients in Group 1 underwent LA and 18 patients in Group 2 underwent OA . The two groups were comparable for age and sex . Children in Group 1 were found to need less parenteral analgesia ( two out of 12 versus six out of 18 ) . Postoperatively , feeds were started earlier in Group 1 than in Group 2 ( 2.5 days versus 3.7 days ) . The average postoperative hospital stay was 5 days in Group 1 and 7.5 days in Group 2 . There were only minor wound infections in Group1 as against two major complications in Group 2 . There was no mortality in either group . Conclusions : In complicated appendicitis , laparoscopic approach carries definite advantages with less postoperative morbidity and hospital stay . It is a feasible and better alternative than the open approach in complicated appendicitis OBJECTIVE Laparoscopic appendectomy for acute appendicitis has become increasingly used over the past decade . The objective of this trend analysis is to assess whether clinical outcomes after laparoscopic appendectomy have improved over the past 12 years . METHODS This analysis is based on the prospect i ve data base of the Swiss Association of Laparoscopic and Thoracoscopic Surgery . All patients undergoing emergency laparoscopic appendectomy for acute appendicitis from 1995 to 2006 were included . The following outcomes were assessed for each of the 12 years : conversion rates , intraoperative complications , surgical postoperative complications , general postoperative complications , rate of reoperations , and length of hospital stay . Unadjusted and risk-adjusted multivariable analyses were performed . Statistical significance was set at a level of P < 0.05 . All statistical tests were 2-sided . RESULTS Data from 7446 patients undergoing laparoscopic appendectomy for acute appendicitis were prospect ively collected . Over the period of observation , the conversion rate decreased significantly from 2.2 % to 1.2 % ( P(trend ) < 0.001 ) , as did intraoperative complications ( from 3.1 % to 0.7 % ; P(trend ) < 0.001 ) , surgical postoperative complications ( from 6.1 % to 1.9 % ; P(trend ) < 0.001 ) , general postoperative complications ( from 4.9 % to 1.5 % ; P(trend ) < 0.001 ) , and rates of reoperations ( from 3.4 % to 0.7 % ; P(trend ) < 0.001 ) . Average postoperative length of hospital stay also significantly decreased from 4.9 to 3.5 days ( P(trend ) < 0.001 ) . CONCLUSIONS Our investigation provides compelling evidence that intraoperative complications , surgical and general postoperative complications , conversion rates , rates of reoperations , and average length of hospital stay have significantly decreased over the past decade in patients undergoing surgery for acute appendicitis . The present trend analysis is the first one in the literature encompassing more than a decade and reporting clinical outcomes after laparoscopic appendectomy for acute appendicitis , which represents an important quality control BACKGROUND In 2012 , a protocol for routine  outpatient laparoscopic appendectomy for uncomplicated appendicitis was published reflecting high success , low morbidity , and significant cost savings . Despite this , national data reflect that the majority of laparoscopic appendectomies are performed with overnight admission . This study up date s our experience with outpatient appendectomy  since our initial report , confirming the efficacy of this approach . METHODS In July 2010 , a prospect i ve protocol for outpatient  laparoscopic appendectomy  was adopted at our institution . Patients were dismissed from the postanesthesia recovery room or day surgery if they met predefined criteria for dismissal . Patients admitted to a hospital room as either full admission or observation status were considered failures of outpatient management . An institutional review board – approved retrospective review of patients undergoing laparoscopic appendectomy for uncomplicated appendicitis from July 2010 through December 2012 was performed to analyze success of outpatient management , postoperative morbidity and mortality , as well as readmission rates . RESULTS Three hundred forty-five patients underwent laparoscopic appendectomy for uncomplicated appendicitis during this time frame . There were 166 men and 179 women , with a mean age of 35 years . Three hundred five patients were managed as out patients , with a success rate of 88 % . Forty patients ( 12 % ) were admitted for preexisting comorbidities ( 15 patients ) , postoperative morbidity ( 6 patients ) , or lack of transportation or home support ( 19 patients ) . Twenty-three patients ( 6.6 % ) experienced postoperative morbidity . There were no mortalities . Four patients ( 1 % ) were readmitted for transient fever , nausea/vomiting , partial small bowel obstruction , and deep venous thrombosis . CONCLUSION Outpatient laparoscopic appendectomy can be performed with a high rate of success , a low morbidity , and a low readmission rate . This study reaffirms our original pilot study and should serve as the basis for a change in the st and ard of care for appendicitis . LEVEL OF EVIDENCE Therapeutic study , level Background : The aim of this study was to evaluate prospect ively whether laparoscopic ( LA ) and open appendectomy ( OA ) are equally safe and feasible in the treatment of pediatric appendicitis . Methods : A total of 517 children with acute appendicitis were r and omly assigned to undergo LA or OA appendectomy , based on the schedule of the attending surgeon on call . Patient age , sex , postoperative diagnosis , operating time , level of training of surgical resident , length of postoperative hospitalization , and minor and major postoperative complications were recorded . Chi-square analysis and the Student t-test were used for statistical analysis . Results : In all , 376 OA and 141 LA were performed . The two groups were comparable in terms of patient demographics and the incidence of perforated appendicitis . The operative time was also similar ( 47.3 ± 19.7 vs 49.9 ± 12.9 min ) . The overall incidence of minor or major complications was 11.2 % in the OA group and 9.9 % in the LA group . Conclusion : Pediatric patients with appendicitis can safely be offered laparoscopic appendectomy without incurring a greater risk for complications . Nevertheless , a higher ( but not significantly higher ) abscess rate was found in patients with perforated appendicitis who underwent laparoscopy BACKGROUND Laparoscopic appendectomy ( LA ) has many advantages over the classic appendectomy ( CA ) , but this method has not been accepted yet in Bosnia and Herzegovina . Therefore , we attempted controlled r and omized study in order to compare classic appendectomy with laparoscopic appendectomy and confirm eventual advantages of caring base of appendix with hem-o-lok clips regarding ordinary accepted endoloop method during laparoscopic appendectomy . METHODS In this prospect i ve study 120 patients were involved which are divided into two groups . In group 1 , 60 patients were operated with classic method  , and group II was divided into two subgroups ; 30 patients were operated with laparoscopic method  in which the base of appendix was cared by double endo-loop method and 30 patients were operated by plastic non-resorptive hem-o-lok clip . During this study the time duration of operation was measured , the duration of application of hem-o-lok and endo-loop , postoperative analgesia , the duration of hospitalization , intra-operative complications , anatomic position of appendix , appendicitis , and postoperative complications . RESULTS The results of the study showed that laparoscopic appendectomy is shorter in duration if compared to the classical appendectomy with statistical significance p < 0.001 ( CA 69,4 min ; LAH 36,6 min ; LAE 37,1 min ) , hospitalization is shorter p < 0.0001 ( CA 3,6 days ; LAH 2,3 days ; LAE 2,2 days ) . Quantity of given analgesics in LA is less than in CA without statistical significance between LAE and CA ( p > 0.340 ) and between LAE and LAH ( p > 0.148 ) while there is positive statistical significance between LAH and CA ( p < 0.015 ) . Precise period of cicatrization of wound of patients operated by CA was 43 ( 71.66 % ) cases , with infection of wound in 3(5 % ) cases , phlegm of wound in 2 ( 3.3 % ) cases , healing of wound per sekundam in 9 ( 15 % ) cases and ileus in one ( 1.6 % ) patient . One patient had an infection of umbilical wound in LA and the other had cellulitis of front abdominal wall . Duration of application of hem-o-lok is shorter compared to endo-loop with statistical significance p < 0.013 ( LAH 68,2 s ; LAE 176,9 s ) . CONCLUSION Time of surgery is shorter and the duration of hospitalization , amount of given analgesic is smaller , less number of postoperative complications , better cosmetic effect and advantages of application of hem-o-lok over endo-loop laparoscopic appendectomy is preferred OBJECTIVE To evaluate the efficacy of diagnostic laparoscopy in patients with suspected acute appendicitis , the number of complications associated with the laparoscopic technique , and the effect of leaving a macroscopically normal-looking appendix in place . DESIGN Three prospect i ve protocol s. SETTING Three departments of surgery , one in Norway and two in Sweden . SUBJECTS 1043 patients aged 15 years or over . INTERVENTIONS Diagnostic laparoscopy in patients with signs and symptoms of acute appendicitis who were to be operated on . MAIN OUTCOME MEASURES Morbidity , mortality , and histological appearance of removed appendices , and outcome whether or not the patient was operated on . RESULTS 819 patients had appendectomies ( 61 % laparoscopically and 39 % by conversion to open operation ) with a total complication rate of 10 % . In 211 patients a diagnostic laparoscopy was done as a single procedure . There were 181 women in this group and 86 of them had gynaecological disorders . The complication rate was 2 % among these 211 patients and after a follow up of two years no patients had been readmitted for appendicectomy . 13 patients were subjected to other open procedures . The overall mortality was 0.4 % . CONCLUSION Diagnostic laparoscopy is safe and can be recommended in patients with suspected acute appendicitis , particularly in women . A macroscopically normal-looking appendix can be left in place
Morbidity was minimal at all ages .
: The data from the current survey and literature review support incidental removal of the appendix in the young patient ( < 35 years old ) .
However , routine incidental appendectomy can not be justified in patients greater than age 50
The results of the two review s were analyzed to formulate guidelines for the appropriateness of performing incidental appendectomy in association with other operative procedures .