Laparoscopy in the prevention of unnecessary appendicectomies: A prospective study

Abstract

More than one-third of all appendicectomies are unnecessary. A study was directed towards reducing the misdiagnosis of appendicitis, thus preventing needless operations. Thirty-six women in the fertile age group and with a diagnosis of appendicitis were subjected to laparoscopy before surgery. All women had undergone a gynaecological examination to rule out disease of the female genitalia. As a result of the laparoscopy, surgery was cancelled in one-third of the cases, which were found to have acute gynaecological disease not requiring surgery.

The Continuing Challenge of Acute Appendicitis

“…Leape and Ramenofsky [55] laparoscoped 32 patients and diagnosed appendicitis in 17.8 were found to have gynaecological disease and 7 were adjudged normal, though 2 of these later underwent appendicectomy; in all 37.5% of patients were spared laparotomy. Similar results were described in a study on fertile women [56]. Laparoscopy in expert hands is a safe procedure with morbidity and mortality rates considerably less than those of negative appendicectomy [56].…”

“…Similar results were described in a study on fertile women [56]. Laparoscopy in expert hands is a safe procedure with morbidity and mortality rates considerably less than those of negative appendicectomy [56]. It would seem to be indicated when the diagnosis is in doubt in women of child-bearing age.…”

Diagnostic Accuracy in 2,351 Patients Undergoing Appendicectomy for Suspected Acute Appendicitis: A Retrospective Study 1986–1993

“…1). One way to increase accuracy could be diagnostic laparoscopy [22, 23]. However, the appendix can be difficult to visualise in 7–28%.…”

Appendicitis Can Be Treated Safely with a Negative Appendectomy Rate of 10%

“…The methods to reduce the negative laparotomy rate include laparoscopy [14], barium enema [4], and ultra sound [15], all of which reportedly improve the diagnos tic accuracy for appendicitis. Computerized algorithms [3,16] and scoring systems [ 17] have also been suggested to decrease the negative appendectomy rate without increasing the perforation rate.…”