What do you do with a normal appearing appendix?: A national study of Pediatric Surgeons

Yasser S. AlFraih; Renad AlMutawa

doi:10.15537/smj.2024.45.9.20240207

Article Figures & Data

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Table 1

- Demographic data of Pediatric Surgeons.

Demographic	n (%)
Total	101
Gender
Male	(78.2) 79
Female	(21.8) 22
Age
25-35	(17.8) 18
36-45	(34.6) 35
46-55	(30.7) 31
56-65	(10.9) 11
>65	(6.0) 6
Current position
Consultant in Pediatric Surgery	58 (57.4)
Specialist in Pediatric Surgery	31 (30.7)
Pediatric Surgery Fellow	2 (2.0)
Pediatric Surgery Resident	10 (9.9)
Country of training
Saudi Arabia	35 (34.6)
Egypt	12 (11.9)
Canada	12 (11.9)
Syria	6 (5.9)
United Kingdom	5 (4.9)
Others	31 (30.7)
Years of practice as a Pediatric Surgeon
Currently in training	12 (11.9)
<5 years	14 (13.9)
5 - 10 years	18 (17.8)
11 - 20 years	29 (28.7)
>20 years	28 (27.7)
Appendectomies per year
0-25	40 (39.6)
26-50	33 (32.7)
51-75	12 (11.9)
76-100	6 (5.9)
>100	10 (9.9)

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Table 2

- Reasons for removal of a normal appearing appendix

Reasons for proceeding with appendectomy when an intra-operative grossly normal appendix is seen in pediatric patients suspected to have appendicitis and no other pathology was found	n (%)
The possibility of microscopic /Endo appendicitis	71 (34.8)
To prevent future appendicitis	28 (13.7)
To avoid future confusion for the patient as to whether they had their appendix removed	51 (25.0)
It improves symptoms post-op	19 (9.3)
The operative consent dictated that you were going to remove the appendix	12 (5.9)
Patient/parent preference based on the consent discussion beforehand	9 (4.4)
Obligation to do something since the child is already in surgery	3 (1.5)
This is how I was trained	11 (5.4)

What is your Gender?	A) male B) female
What is your age?	A) 25> B) 25-35 C) 36-45 D) 46-55 E) 56-65 F) 65<
What is your current position?	A) Consultant in Pediatric Surgery B) Specialist in Pediatric Surgery C) Pediatric Surgery Fellow D) Pediatric Surgery Resident E) Retired Pediatric Surgeon
Where did you complete your Pediatric Surgery training?
In which region of Saudi Arabia are you currently practicing?	A) Central (Riyadh and Qasim) B) Western (Mecca, Medina, Jeddah) C) Eastern (Dammam, Khafji, Al Hasa) D) Northern (Tabuk, Jouf, Hail) E) Southern (Asir, Najran, Jizan)
How many years have you been practicing as a pediatric surgeon ?	A) Currently in training B) Less than 5 years C) 5 - 10 years D) 11 - 20 years F) more than 20 years
In your individual practice, approximately how many appendectomies do you perform per year ?	A) 0-25 B) 26-50 C) 51-75 D) 76-100 E) >100
What is your preferred method of appendectomy?	A) Open B) Laparoscopic
Do you prefer to have pre-operative imaging even when the physical and history support a diagnosis of appendicitis? If Yes then what kind of imaging do you obtain ?	A) No, I don’t prefer preoperative imaging B) Yes, Ultrasound C) Yes, CT D) Yes, Plain radiograph E) Other
You are performing a laparoscopic appendectomy for suspected acute uncomplicated appendicitis and the appendix appears structurally normal. You do not find any other obvious cause for the patient’s symptoms. Do you remove this appendix ?	A) Yes B) No
Why would you choose to remove this appendix ? Check all that apply.	A) I would not remove the appendix B) The possibility of microscopic /Endo appendicitis C) To prevent future appendicitis D) To avoid future confusion for the patient as to whether they have had their appendix removed or not E) It improves symptoms post-op F) The operative consent dictated that you were going to remove the appendix G) Patient/parent preference based on the consent discussion beforehand H) Obligation to do something since the child is already in surgery I) This is how I was trained
Why would you choose NOT to remove this appendix ? Check all that applies	A) I would remove the appendix B) Based on the scenario there is no evidence that the appendix is causing the patient’s symptoms C) Unnecessary risk of postoperative complications D) Possible use of the appendix in reconstructive benefit in the future E) This is how I was trained
Do you feel that there are sufficient guidelines on the topic of weather or not to remove a normal-appearing appendix during laparoscopy for suspected acute appendicitis ?	A) Yes B) No
In your individual practice, have you ever removed an appendix that pathology later deemed to be normal (negative appendectomy)?	A) Yes B) No