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Surgical Endoscopy

, Volume 14, Issue 10, pp 942–947 | Cite as

Introducing diagnostic laparoscopy for patients with suspected acute appendicitis

  • A. C. Moberg
  • A. Montgomery
Original Articles

Abstract

Background

The diagnostic accuracy in patients with suspected acute appendicitis varies from 60% to 90% depending on age and gender. The aim of this study was to evaluate the use of diagnostic laparoscopy for diagnostic purposes in patients with suspected acute appendicitis to prevent unnecessary laparotomy and to leave a macroscopically normal appendix in place.

Methods

For this study, 500 consecutive patients with suspected acute appendicitis admitted between January 1994 and October 1996 were included prospectively in a surgical training program set to provide diagnostic laparoscopy on a 24-h-a-day basis. Primary open operation was performed when no laparoscopically trained surgeon was available. Short-term outcome measurements were recorded, and a retrospective long-term follow-up evaluation was performed.

Results

We succeeded in performing a diagnostic laparoscopy in 376 patients and a primary open operation in 124 patients. The overall appendicitis rate was 78%. A diagnostic laparoscopy alone was performed in 66 patients (56 of which were fertile women), with a median operating time of 36 min and a complication rate of 0%. The overall complication rate was 8.0%. During a median follow-up period of 19 months one patient returned on a later occasion with appendicitis. At completion of the study, 85% of the surgeons were skilled in diagnostic laparoscopy.

Conclusions

Substantial education effort is needed to introduce diagnostic laparoscopy on a 24-h-a-day basis. Diagnostic laparoscopy has a high rate of accuracy, short operating time, and low associated morbidity, and prevents unnecessary laparotomy. It is possible to leave a macroscopically normal-appearing appendix in place.

Key words

Appendicitis Diagnostic laparoscopy Laparoscopic appendicectomy 

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References

  1. 1.
    Adamek HE, Maier M, Benz C, Huber T, Schilling D, Riemann JF (1996) Schwerwiegende komplikationen der diagnostischen laparoskopie. Med Klin 91: 694–697Google Scholar
  2. 2.
    Addiss GD, Shaffer N, Fowler S, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132: 910–925CrossRefGoogle Scholar
  3. 3.
    Andersson RE, Hugander A, Thulin AJG (1992) Diagnostic accuracy and perforation rate in appendicitis: association with age and sex of patient and with appendicectomy rate. Eur J Surg 158: 37–41PubMedGoogle Scholar
  4. 4.
    Arnbjörnsson E (1984) Small intestinal obstruction after appendectomy: an avoidable complication? Curr Surg 354–355Google Scholar
  5. 5.
    Arnbjörnsson E, Andrén-Sandberg Å, Bengmark S (1983) Appendicectomy in the elderly, incidence and operative findings. Ann Chir Gyn 72: 223–228Google Scholar
  6. 6.
    Attwood SEA, Hill ADK, Murphy PG, Thornton J, Stephens RB (1992) A prospective randomized trial of laparoscopic vs open appendictomy. Surgery 112: 497–501PubMedGoogle Scholar
  7. 7.
    Birkenfeld A, Brzezinski A, Schenker JG (1982) Post mechanical sterility. Acta Eur Fertil 13: 173–176PubMedGoogle Scholar
  8. 8.
    Blind PJ, Dahlgren ST (1986) The continuing challange of the negative appendix. Acta Chir Scand 152: 623–627PubMedGoogle Scholar
  9. 9.
    Bonjer HJ, Hazebroek EJ, Kazemier G, Giuffrida MC, Meijer WS, Lange JF (1997) Open vs closed establishment of pneumoperitoneum in laparoscopic surgery. Br J Surg 84: 599–602CrossRefGoogle Scholar
  10. 10.
    Borgstein PJ, Gordijn RV, Eijsbouts QAJ, Cuesta MA (1997) Acute appendicitis: a clear-cut case in men, a guessing game in women. Surg Endosc 11: 923–927CrossRefGoogle Scholar
  11. 11.
    Cang FC, Hogle HH, Welling DR (1973) The fate of the negative appendix. Am J Surg 126: 752–754CrossRefGoogle Scholar
  12. 12.
    Champault G, Cazacu F, Taffinder N (1996) Serious trocar accidents in laparoscopic surgery: a French survey of 103,852 operations. Surg Laparosc Endosc 6: 367–370CrossRefGoogle Scholar
  13. 13.
    Cox MR, McCall JL, Padbury RTA, Wilson TG, Wattchow DA, Toouli J (1995) Laparoscopic surgery in women with a clinical diagnosis of acute appendicitis. Med J Aust 162: 130–132PubMedGoogle Scholar
  14. 14.
    Deutsch AA, Zelikovsky A, Reiss R (1982) Laparoscopy in the prevention of unnecessary appendicectomies: a prospective study. Br J Surg 69: 336–337CrossRefGoogle Scholar
  15. 15.
    De Wilde RL (1991) Goodbye bowel obstruction after appendicectomy. Lancet 338: 1012CrossRefGoogle Scholar
  16. 16.
    Frazee RC, Roberts JW, Symmonds RE, Snyder SK, Hendricks JC, Smith RW, Custer MD, Harrison JB (1994) A prospective randomized comparing open vs laparoscopic appendectomy. Ann Surg 219: 725–731CrossRefGoogle Scholar
  17. 17.
    Fritts LL, Orlando R (1993) Laparoscopic appendectomy: a safety and cost analysis. Arch Surg 128: 521–525CrossRefGoogle Scholar
  18. 18.
    Graham A, Henley C, Mobley J (1991) Laparoscopic evaluation of acute abdominal pain. J Laparosc Surg 1: 165–168CrossRefGoogle Scholar
  19. 19.
    Hansen JB, Smithers BM, Schache D, Wall, DR, Miller BJ, Menzies BL (1996) World J Surg 20: 17–21CrossRefGoogle Scholar
  20. 20.
    Heinzelmann M, Simmen HP, Cummins AS, Largiader F (1995) Is laparoscopic appendectomy the new “gold standard”? Arch Surg 130: 782–784CrossRefGoogle Scholar
  21. 21.
    Hellberg A (1999) Prospective randomized multicenter study of laparoscopy vs open appendicectomy. Br J Surg 86: 48–53CrossRefGoogle Scholar
  22. 22.
    Henle K, Beller S, Rechner J, Zerz A (1996) Laparoskopische vs konventionelle appendektomie: eine prospektive, randomisierte studie. Chirurg 67: 526PubMedGoogle Scholar
  23. 23.
    Jansen FW, Kapiteyn K, Trimbos-Kemper T, Hermans J, Trimbor JB (1997) Br J Obstet Gynecol 104: 595–600CrossRefGoogle Scholar
  24. 24.
    Kok HJM (1992) Laparoscopic appendectomy: a new opportunity for curing appendiocopathy. Surg Lap End 2: 297–302Google Scholar
  25. 25.
    Krähenbühl L, Frei E, Klaiber Ch, Büchler MW (1998) Acute appendicitis standard treatment or laparoscopic surgery. In: Büchler MW, Farthmann EH (eds) Progress in surgery. Karger, Basel, pp 1–191Google Scholar
  26. 26.
    Kum CK, Ngoi SS, Goh PMY, Tekant Y, Isaac JR (1993) Randomized controlled trial comparing laparoscopic and open appendicectomy. Br J Surg 80: 1599–1600CrossRefGoogle Scholar
  27. 27.
    Laine S, Rantala A, Gullichsen R, Ovaska J (1997) Laparoscopic appendectomy: is it worthwhile? Surg Endosc 11: 95–720CrossRefGoogle Scholar
  28. 28.
    Lau WY, Fan ST, ylu TF, Chu KW, Wong SH (1984) Negative findings at appendectomy. Am J Surg 148: 375–378CrossRefGoogle Scholar
  29. 29.
    Leape LL, Ramenofsky ML (1980) Laparoscopy for questionable appendicitis: can it reduce the negative appendectomy rate? Ann Surg 191: 410–413CrossRefGoogle Scholar
  30. 30.
    Lehmann-Willenbrock E, Mecke H, Reidel HH (1990) Sequele of appendectomy, with special reference to intra-abdominal adhesions, chronic abdominal pain, and infertility. Gyn Obst 29: 241–245Google Scholar
  31. 31.
    Macarulla E, Vallet J, Abad JM, Hussein H, Fernández E, Nieto B (1997) Laparoscopic vs open appendectomy: a prospective randomized trial. Surg Lap Endosc 7: 335–339CrossRefGoogle Scholar
  32. 32.
    Martin LC, Puente I, Sosa JL, Bassin A, Breslaw R, McKenney MG, Ginzburg E, Sleeman D (1995) Open vs laparoscopic appendectomy. Ann Surg 222: 256–262CrossRefGoogle Scholar
  33. 33.
    McAnena OJ, Austin O, O’Connell PR, Hederman WP, Gorey TF, Fitzpatrick J (1992) Laparoscopic vs open appendicectomy: a prospective evaluation. Br J Surg 79: 818–820CrossRefGoogle Scholar
  34. 34.
    Moberg A, Ahlberg G, Leijonmarck CE, Montgomery A, Reiertsen O, Rosseland AR (1988) Diagnostic laparoscopy in 1,043 patients with suspected acute appendicitis. Eur J Surg 164: 833–840CrossRefGoogle Scholar
  35. 35.
    Moberg AC, Montgomery A (1997) Appendicitis: laparoscopic vs conventional operation: a study and review of the literature. Surg Laparosc Endosc 7: 459–463CrossRefGoogle Scholar
  36. 36.
    Mutter D (1996) Laparoscopy not recommended for routine appendectomy in men: results of a prospective randomized study. Surgery 10: 71–74CrossRefGoogle Scholar
  37. 37.
    Nagy AG, James D (1989) Diagnostic laparoscopy. Am J Surg 157: 3CrossRefGoogle Scholar
  38. 38.
    Olsen JB, Myrén CJ, Haahr PE (1993) Randomized study of the value of laparoscopy before appendicectomy. Br J Surg 80: 922–923CrossRefGoogle Scholar
  39. 39.
    Ortega AE, Hunter JG, Peters JH, Swanstrom LL, Schirmer B (1995) A prospective, randomized comparison of laparoscopic appendectomy with open appendectomy. 169: 208–212Google Scholar
  40. 40.
    Pedersen AG, Petersen OBB, Wara P, Qvist N, Laurberg S (1996) Laparoskopi ved formodet appendicitis acuta. Ugeskr Laeger 158: 2377–2380PubMedGoogle Scholar
  41. 41.
    Pieper R, Kager L, Näsman P (1982) Acute appendicitis: a clinical study 1,018 cases of emergency appendectomy. Acta Chit Scand 148: 51–62Google Scholar
  42. 42.
    Pier A, Götz F, Bacher C, Ibald R (1993) Laparoscopic appendectomy. World J Surg 17: 29–33CrossRefGoogle Scholar
  43. 43.
    Reiertsen O, Larsen S, Edwin B, Faerden AE, Rosseland AR (1997) A randomized controlled trial with sequential design of laparoscopic vs conventional appendicectomy. Br J Surg 84: 482–486CrossRefGoogle Scholar
  44. 44.
    Riber C, Søe K, Jørgensen T, Tønnesen H (1997) Intestinal after appendectomy. Scand J Gast 32: 1125–1128CrossRefGoogle Scholar
  45. 45.
    Richards W, Watson D, Lynch G, Reed GW, Olsen D, Spaw A, Holcomb W, Frexes-Steed M, Goldstein R, Sharp K (1993) A review of the results of laparoscopic vs open appendectomy. Gynecol Obstet 177: 473–480Google Scholar
  46. 46.
    Scott-Conner CEH, Hall TJ, Anglin BL, Muakkassa FF (1992) Laparoscopic appendectomy. Ann Surg 215: 660–668CrossRefGoogle Scholar
  47. 47.
    Semm K, Mettler L (1980) Progress in pelvic surgery via operative laparoscopy. Am J Obstet Gynecol 138: 121–127CrossRefGoogle Scholar
  48. 48.
    Silberman VA (1981) Appendectomy in a large metropolitan hospital. Am J Surg 142: 615–618CrossRefGoogle Scholar
  49. 49.
    Slim K, Pezet D, Chipponi J (1998) Laparoscopic or open appendectomy? Dis Colon Rectum 41: 398–405CrossRefGoogle Scholar
  50. 50.
    Spirtos NM, Eisenkop SM, Spirtos TW, Poliakin RI, Hibbard LT (1987) Laparoscopy, a diagnostic aid in cases of suspected appendicitis: its use in women of reproductive age. Am J Obstet Gynecol 156: 90CrossRefGoogle Scholar
  51. 51.
    Tanphiphat C, Chittmittrapap S, Prasopsunti K (1987) Adhesive small bowel obstruction: a review of 321 cases in a Thai hospital. Am J Surg 154: 283–287CrossRefGoogle Scholar
  52. 52.
    Tate JJT, Dawson JW, Chung SCS, Lau WY, Li AKC (1993) Laparoscopic vs open appendicectomy: a prospective randomized trial. Lancet 342: 633–637CrossRefGoogle Scholar
  53. 53.
    Taylor EM, Kennedy CA, Dunham RH, Bloch JH (1995) Diagnostic laparoscopy in women with acute abdominal pain. Surg Laparosc Endosc 5: 125–128PubMedGoogle Scholar
  54. 54.
    Tronin RJ, Burova VA, Grinberg AA (1996) Laparoscopic diagnosis of acute appendicitis in women. J Am Assoc Gynecol Laparosc 3: 257–261CrossRefGoogle Scholar
  55. 55.
    Walker SJ, West CR, Colmer MR (1995) Acute appendicitis: does removal of a normal appendix matter, what is the value of diagnostic accuracy, and is surgical delay important? Ann R Coll Surg Engl 77: 358–363PubMedPubMedCentralGoogle Scholar
  56. 56.
    Zbar RIS, Crede WB, Mckhann CF, Jekel JF (1993) The postoperative incidence of small bowel obstruction following standard, open appendectomy and cholecystectomy. Conn Med 57: 123–127PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2000

Authors and Affiliations

  • A. C. Moberg
    • 1
  • A. Montgomery
    • 1
  1. 1.Department of SurgeryMalmö University HospitalMalmöSweden

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