Authors: S Garbarino S M Shimi
Publish Date: 2008/03/26
Volume: 23, Issue: 3, Pages: 527-533
Abstract
The reported negative appendicectomy rate for young women remains high This high rate of unnecessary appendicectomies has morbidity and high cost Consensus European Association of Endoscopic Surgeons EAES guidelines have emphasised the value of routine laparoscopy as a diagnostic tool in young women The objective of this study is to investigate the role of routine laparoscopy in the diagnosis of suspected appendicitis in young womenThe details of young female patients who have had an appendicectomy with or without laparoscopy between 1980 and 2005 were obtained The histopathological reports pertaining to the episode of appendicectomy were manually searched Three periods were identified for comparison The first period was between 1980 and 1990 when diagnostic laparoscopy was not practised in the emergency setting The second period was between 1991 and 1999 when diagnostic laparoscopy was used selectively The third period was between 2000 and 2005 when diagnostic laparoscopy was used routinely to investigate female patients presenting with acute right iliac fossa painSelective laparoscopy reduced the rate of negative appendicectomy rate from 37 to 31 ns By contrast routine laparoscopy reduced the negative appendicectomy rate to 5 p 0005 Additionally considering the ratios of all appendectomies to normal appendices an average of one in three appendices excised was normal before the era of laparoscopy The selective use of laparoscopy did not significantly alter this ratio ns By contrast routine use of laparoscopy has altered the ratio to 1 in 20 appendices removed to be normal p 0001In young females diagnostic laparoscopy used selectively reduces the rate of negative appendicectomy but not significantly However when used routinely laparoscopy significantly reduces the rate of negative appendicectomy Diagnostic laparoscopy should be used routinely for all young females presenting with right iliac fossa pain sufficiently severe to warrant surgical exploration
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