Stechman M J, Roy D, Mainprize K S
Department of Surgery, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
Colorectal Dis. 2009 Oct;11(8):817-20. doi: 10.1111/j.1463-1318.2008.01716.x. Epub 2008 Oct 21.
Diagnostic laparoscopy is advocated in the management of patients with acute right iliac fossa pain. We asked consultant surgeons in the UK about their current use of this technique.
A short anonymous questionnaire was sent to consultant surgeons from the ASGBI database. Information was sought on general surgical specialty, participation in the emergency surgical on-call rota, current practice regarding the use of diagnostic laparoscopy in patients with suspected acute appendicitis and on the management of an inflamed or noninflamed appendix. Statistical analysis was by means of chi(2) test.
There were 161 eligible returns from 250 questionnaires (64%) and the proportion of consultants replying from each subspecialty was similar to membership numbers of subspecialty organizations. Most consultants (68%) performed diagnostic laparoscopy in patients with suspected acute appendicitis. The majority (69%) reserved its use for women of reproductive age and 14% of respondents laparoscoped all patients with suspected appendicitis. Compared to nongastrointestinal (GI), GI surgeons were significantly more likely to perform diagnostic laparoscopy (75 vs 52%, P = 0.008). In the case of an overtly inflamed appendix, 81% of respondents would remove it laparoscopically with significantly more GI surgeons following this course than nonGI surgeons (P = 0.04).
Despite good evidence on the benefits of diagnostic laparoscopy in certain patients with suspected acute appendicitis, there is significant variation in its use. This difference appears to be based upon subspecialty and may be as a result of increasing subspecialization.
