PRACTICE OF SURGEONS REGARDING EXAMINATION OF PATHOLOGICAL SPECIMENS IN OPERATING ROOM

Authors

  • Abdul Samad
  • Basant Kumar
  • Tariq Wahab Khanzada

Abstract

Background: The debate of routine versus selective submission of specimens for histopathologymakes it important to know the present practice of surgeons. The objective of this study was todetermine the proportion of general surgeons examining the gall bladder and appendix specimensin operating room before submission for histopathology. Methods: This questionnaire basedsurvey was conducted for the general surgeons working in the city of Hyderabad, Pakistan duringMay-June 2008. The data was entered and analysed in SPSS 11.0 software statistical program todetermine the impact of designation, hospital category and experience on the responses ofsurgeons. Results: Overall, 42 out of 47 qualified general surgeons working in Hyderabad,Pakistan responded the questionnaire. About 23.8% and 4.8% reported to be always examininggall bladder and appendix specimens respectively in operating room. About 66.7% and 40.5%reported to be submitting every gall bladder and appendix specimen respectively forhistopathology. Lack of practice and poverty were reported as the common causes of notexamining the specimen in operating room and not submitting every specimen for histopathologyrespectively. About 25.8% and 81.8% from public and private sector hospitals respectivelyreported to be submitting every appendix specimen for histopathology. About 88.2% and 52% ofsurgeons having experience of five years or less and experience of more than five yearsrespectively reported to be submitting every gall bladder specimen for histopathology.Conclusions: There is widespread variation in the practice of general surgeons regardingoperating room examination as well as submission of specimens for histopathology.Keywords: General surgeons, Macroscopic examination, Operating room, Histopathology

References

Anthony PP. A hitchhikers guide to survival in

histopathology. Bull Royal Coll Pathol 1998;101:32–4.

Alun-Jones T, Hill J, Leighton SE, Morrissey MS. Is routine

histological examination of nasal polyps justified? Clin

Otolaryngol Allied Sci 1990;15:217–9.

Brooks SG, Hughes RG. Selective histopathology for

appendix specimens. Lancet 1987;2(8575):1456.

Wenner WJ Jr, Gutenberg M, Crombleholme T, Flickinger C,

Bartlett SP. The pathological evaluation of the pediatric

inguinal hernia sac. J Pediatr Surg 1998;33:717–8.

Cataldo PA, MacKeigan JM. The necessity of routine

pathologic evaluation of hemorrhoidectomy specimens. Surg

Gynecol Obstet 1992;174:302–4.

Raab SS. The cost effectiveness of routine histologic

examination. Am J Clin Pathol 1998;110:391–6.

Wolkomir AF, Barone JE, Moser RL. Selective microscopic

examination of gall bladders, hernia sacs and appendices. Am

Surg 1991;57:289–92.

Kassan MA, Munoz E, Laughlin A, Margolis IB, Wise L.

Value of routine pathology in herniorrhaphy performed upon

adults. Surg Gynecol Obstet 1986;163:518–22.

Partrick DA, Bensard DD, Karrer FM, Ruyle SZ. Is routine

pathological evaluation of pediatric hernia sacs justified? J

Pediatr Surg 1998;33:1090–2; discussion 1093–4.

Chan W, Fu KH. Value of routine histopathological

examination of appendices in Hong Kong. J Clin Pathol

;40:429–33.

Fitzgibbons P, Cleary K. CAP offers recommendations on

selecting surgical specimens for examination. CAP Today

;10(7):40.

Zarbo RJ, Nakhleh RE. Surgical pathology specimens for

gross examination only and exempt from submission: A

College of American Pathologists Q-Probes study of current

policies in 413 institutions. Arch Pathol Lab Med

;123:133–9.

Cross SS, Stone JL. Proactive management of histopathology

workloads: analysis of the UK Royal College of Pathologists’

recommendations on specimens of limited or no clinical

value on the workload of a teaching hospital gastrointestinal

pathology service. J Clin Pathol 2002;55:850–2.

Royal College of Pathologists. Histopathology and

cytopathology of limited or no clinical value (2nd Ed).

London: Royal College of Pathologists; 2005.

Salmon HA, Smith JH, Balsitis M. Is microscopic assessment

of macroscopically normal hysterectomy specimens

necessary? J Clin Pathol 2000;55:67–8.

Bondeson L, Linell F, Ringberg A. Breast reductions; What

to do with all the tissue specimens. Histopathology

;9:281–5.

Speake WJ, Abercrombie JF. Should doughnut histology be

routinely performed following anterior resection for rectal

cancer? Ann R Coll Surg Engl 2003;85(1):26–7.

Smoot EC III. Does this go to pathology? Plast Reconstr Surg

;81809. (Letter).

Taylor HW, Huang JK. Routine pathological examination of

the gall bladder is a futile exercise. Br J Surg 1998;85:208.

Bazoua G, Hamza N, Lazim T. Do we need histology for a

normal looking gall bladder? J Hepatobiliary Pancreat Surg

;14:564–8.

Darmas B, Mahmud S, Abbas A, Baker AL. Is there any

justification for the routine histological examination of

straightforward cholecystectomy specimens? Ann R Coll

Surg Engl 2007;89:238–41.

Dix FP, Bruce IA, Krypcyzk A, Ravi S. A selective approach

to histopathology of the gall bladder is justifiable. Surgeon

;1:233–5.

Matthyssens LE, Ziol M, Barrat C, Champault GG. Routine

surgical pathology in general surgery. Br J Surg

;93(3):362–8.

Royal College of Pathologists. Histopathology of limited or

no clinical value. Report of working group of the Royal

College of Pathologists. London: Royal College of

Pathologists; 2002.

Samad A. Gall bladder carcinoma in patients undergoing

cholecystectomy for cholelithiasis. J Pak Med Assoc

;55:497–9.

J Ayub Med Coll Abbottabad 2009;21(4)

http://www.ayubmed.edu.pk/JAMC/PAST/21-4/Samad.pdf

Akyurek N, Irkorucu O, Salman B, Erdem O, Sare M,

Tatlicioglu E. Unexpected gall bladder cancer during

laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg

;11:357–61.

Perpetuo MD, Valdivieso M, Heilbrun LK, Nelson RS,

Connor T, Bodey GP. Natural history study of gall bladder

cancer: a review of 36 years experience at M.D. Anderson

Hospital and Tumor Institute. Cancer 1978;42:330–5.

Henson DE, Albores-Saavedra J, Corle D. Carcinoma of the

gall bladder. Histologic types, stage of disease, grade and

survival rates. Cancer 1992;70:1493–7.

Marudanayagam R, Williams GT, Rees BI. Review of the

pathological results of 2660 appendicectomy specimens. J

Gastroenterol 2006;41:745–9.

Jones AE, Phillips AW, Jarvis JR, Sargen K. The value of

routine histopathological examination of appendicectomy

specimens. BMC Surg 2007;7:17.

Gilmore OJ, Browett JP, Griffin PH, Ross IK, Brodribb AJ,

Cooke TJ. Appendicitis and mimicking conditions. A

prospective study. Lancet 1975;2:421–4.

Downloads

Published

2009-12-01