“What You See Is Not What You Get” A Plea to Remove A ‘Normal’ Appendix During Diagnostic Laparoscopy

Abstract.

Background: Diagnostic laparoscopy (DL) is a well established alternative option to coeliotomy for suspected appendicitis. When a ‘normal’ appendix is found, appendectomy is often believed unnecessary. Little is known however about how normal a normal appearing appendix is. In this study we postulated that a normal appendix seen at DL, may show pathological indications at microscopy, and thus, to leave the appendix untouched may be unsafe.

Methods: A retrospective review of data from 48 patients which, in a five year period (1995–1999), had virtually normal appendices removed as completion of DL for lower abdominal pain.

Results: No procedure-related drawback and no subsequent complications were recorded. Symptoms subsided in all the patients. Mean hospital stay was 2.1 days. When receiving specimens, incidence of pathologic changes of the appendix were observed in 58 percent of the cases (n = 28). The negative predictive value of DL was 41 percent.

Conclusions: Due to the consistently false negative rate of DL, and the low morbidity rate for laparoscopic appendectomy, we support incidental appendectomy in patients with lower abdominal pain.

Key words:

• Acute abdomen
• laparoscopy
• appendectomy