Diagnostic laparoscopy in 1043 patients with suspected acute appendicitis.

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 appendectomies (61% laparoscopically and 39% by conversion 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.