Diagnostic laparoscopy in 1043 patients with suspected acute appendicitis

Abstract

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 prospective protocols. 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 appendicectomies (61% laparoscopically and 39% by convertion 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.