Abstracts
2000 Digestive Disease Week

# 2285 Diagnostic Laparoscopy in Acute Appendicitis.
Marc J. P. M. Govaert, Laurens Th. De Wit, Peter Van Duijvendijk, Dirk J. Gouma, Amsterdam, Netherlands

Background: Negative exploration for suspected appendicitis has been reported between 20-30%. Previously this high rate has been accepted because of fear for missing acute appendicitis and subsequent perforation. Diagnostic laparoscopy has been advocated in lower abdominal pain to reduce negative explorations. It is however debatable if diagnostic laparoscopy should be performed in all patients. Therefore the aim of this study was to determine the value of diagnostic laparoscopy in patients with suspected acute appendicitis and to analyze differences between male and female patients. Methods: All adult patients (age 16-82 years) with the clinical diagnosis appendicitis and indication for exploration were included. Ultrasound and CT-scan were not performed routinely in these patients. These patients went for diagnostic laparoscopy and appendectomy was only performed if an inflamed appendix was found and removed either laparoscopically or by laparotomy. Results: In this prospective study 219 consecutive patients were included in 27 months. Twenty-four underwent direct appendectomy due to logistic reasons and were excluded from further analysis. The remaining 195 patients (106 F, 89 M) underwent diagnostic laparoscopy. A normal appendix was found in 47 patients (24.1%) respectively in 44 women (41.3%) and 3 men (3.4%). In male patients the clinical diagnosis was correct in 96.6%. In female patients negative findings were mainly caused by gynaecological disorders 9 (n=12) The appendix was removed laparoscopically in 36 patients (24%), by muscle-splitting McBurney incision in 108 (73%) and in 5 patients (3.4%) by median laparotomy. Except for patients who underwent median laparotomy, no differences were found in complication rate or hospital stay between the laparoscopic and open appendectomy. Conclusions: Diagnostic laparoscopy seems to be indicated in women because in 41% appendicitis was not confirmed and exploration could be prevented. In male patients the additive value of laparoscopy is minimal (3%) and laparoscopy should only be performed if the appendix is also laparoscopically removed.