{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T07:46:27Z","timestamp":1791963987460,"version":"4.3.4"},"reference-count":33,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Guidelines recommend laparoscopic appendectomy (LA) for a macroscopically normal appendix when no pathology is identified during diagnostic laparoscopy (DL) for suspected acute appendicitis (AA). This approach may lead to increased hospitalization, higher costs, and greater morbidity. Whether these guidelines are justified remains debatable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included all patients aged &gt;\u00a02\u00a0years undergoing DL for suspected AA at four Danish University hospitals from March 2017 to April 2021. Patients undergoing LA despite normal intraoperative findings were compared with patients with normal intraoperative findings undergoing DL only. Sensitivity analyses included patients with incidental intraoperative gynecological or histopathological findings not corresponding with the symptoms. The primary outcome was subsequent DL for suspected AA during follow\u2010up, and the main secondary outcomes were complications within 30\u00a0days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      627 patients underwent DL and 518 underwent LA. Median follow\u2010up was 5.2\u00a0years (IQR 4.1\u20136.1) and 5.7\u00a0years (IQR 4.5\u20136.6), respectively. At a median of 1.7\u00a0years (IQR 0.7\u20133.4), 3.5% (95% CI 2.0\u20134.9) of the DL group underwent a second DL for suspected AA, with a subsequent 0.96% risk of AA. In the main analyses, no significant differences between the groups were observed for subsequent intra\u2010abdominal surgery, gastrointestinal endoscopy or surgical complications. In sensitivity analyses, surgical complications occurred significantly more frequently after LA (3.7% vs. 1.6% after DL,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.02), mainly driven by a trend toward a higher risk of intra\u2010abdominal bleeding (0.6% vs. 0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.056) and intra\u2010abdominal abscess.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The risks of both subsequent DL and AA following initial DL are minimal. The risk of increased surgical complications after LA is low, and the clinical relevance is questionable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70571","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T08:29:40Z","timestamp":1789806580000},"page":"2917-2926","source":"Crossref","is-referenced-by-count":0,"title":["Preservation Versus Routine Removal: Morbidity and Long\u2010Term Outcomes Following Diagnostic Laparoscopy Versus Negative Appendectomy\u2014A Regional Multicentre Observational Cohort Study"],"prefix":"10.1002","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3192-3022","authenticated-orcid":false,"given":"Katrine Folmann","family":"Finne","sequence":"first","affiliation":[{"name":"Department of Surgery Copenhagen University Hospital\u2014North Zealand  Hiller\u00f8d Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6816-4110","authenticated-orcid":false,"given":"Liv","family":"Hornnes","sequence":"additional","affiliation":[{"name":"Department of Surgery Copenhagen University Hospital\u2014North Zealand  Hiller\u00f8d Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4393-866X","authenticated-orcid":false,"given":"Anders","family":"Bang\u2010Nielsen","sequence":"additional","affiliation":[{"name":"Department of Surgery Copenhagen University Hospital\u2014North Zealand  Hiller\u00f8d Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7900-7036","authenticated-orcid":false,"given":"Aya Nihad Abdulrahman","family":"Abdulrahman","sequence":"additional","affiliation":[{"name":"Digestive Disease Center Copenhagen University Hospital\u2014Bispebjerg  Copenhagen Denmark"},{"name":"Gastrounit Copenhagen University Hospital\u2014Amager and Hvidovre  Hvidovre Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9169-1622","authenticated-orcid":false,"given":"Talha","family":"Malik","sequence":"additional","affiliation":[{"name":"Department of Surgery Copenhagen University Hospital\u2014Herlev and Gentofte  Herlev Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4796-9030","authenticated-orcid":false,"given":"Peter Cornelius Helbo","family":"Jakobsen","sequence":"additional","affiliation":[{"name":"Department of Surgery Copenhagen University Hospital\u2014North Zealand  Hiller\u00f8d Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7465-5374","authenticated-orcid":false,"given":"Lars Nannestad","family":"J\u00f8rgensen","sequence":"additional","affiliation":[{"name":"Digestive Disease Center Copenhagen University Hospital\u2014Bispebjerg  Copenhagen Denmark"},{"name":"Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9330-0410","authenticated-orcid":false,"given":"Jakob","family":"Kleif","sequence":"additional","affiliation":[{"name":"Department of Surgery Copenhagen University Hospital\u2014North Zealand  Hiller\u00f8d Denmark"},{"name":"Gastrounit Copenhagen University Hospital\u2014Amager and Hvidovre  Hvidovre Denmark"},{"name":"Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6337-8447","authenticated-orcid":false,"given":"Claus Anders","family":"Bertelsen","sequence":"additional","affiliation":[{"name":"Department of Surgery Copenhagen University Hospital\u2014North 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