Value of diagnostic laparoscopy in fertile women with suspected appendicitis

Abstract

Objective: To assess the value of diagnostic laparoscopy in women of child-bearing age with suspected appendicitis.

Design: Prospective, non-randomised study.

Setting: University hospital, Sweden.

Subjects: 94 women aged between 15 and 40 years with suspected appendicitis.

Intervention: Diagnostic laparoscopy. If necessary, the appendix was removed either laparoscopically or by open operation. The outcomes were compared with those during 1994, during which all appendicectomies were done through a laparotomy.

Main outcome measures: Rates of unnecessary appendicectomy, operating time, and length of hospital stay.

Results: 77 had diagnostic laparoscopy, and 17 primary open appendicectomy. 73 appendixes were removed; 53 open and 20 laparoscopically. 12 appendicectomies (13%) were unnecessary compared with 27/80 (34%) during the year 1994. The duration of the open operation was significantly shorter (mean (SD) 35 (14) minutes) than the laparoscopic one (78 (18) minutes) (p<0.001), and there were no differences in duration of postoperative hospital stay. No patients developed complications.

Conclusions: Diagnostic laparoscopy is safe and helpful in suspected cases of appendicitis and could substantially reduce the rate of unnecessary appendicectomies. However, the data suggest that laparoscopic appendicectomy offers no advantages over primary open appendicectomy in terms of postoperative course.