DIAGNOSTIC LAPAROSCOPY FOR SUSPECTED APPENDICITIS

One hundred consecutive patients who underwent diagnostic laparoscopy for suspected appendicitis were evaluated to assess the appropriate cl inical setting for laparoscopic appendectomy. The usefulness of diagno stic laparoscopy in the setting of acute abdominal pain has been well documented. However, there is debate about the use of laparoscopy for definitive therapy. The purpose of this study is to evaluate the decis ion making process during diagnostic laparoscopy for suspected appendi citis. When pathology is identified other than in the appendix, the ma jority of patients can be treated without converting to an open proced ure. In patients found to have no obvious pathology, incidental append ectomy can be performed laparoscopically. When appendicitis was identi fied, the majority of patients could be treated safely without convert ing to an open technique. However, there were certain clinical situati ons that necessitated conversion to an open operation. Involvement of the cecum or perforation at the base of the appendix puts the appendic eal stump at risk for leak and abscess formation. Evaluation of the ce cum by palpation for a mass should also be performed in this situation . Another situation in which conversion to an open technique is warran ted is an appendiceal abscess with adherent small bowel. The friabilit y of bowel wall greatly increases the risk for bowel injury in this se tting. Laparoscopy is a useful technique for the diagnosis and treatme nt of abdominal pain even if the appendix is normal on inspection. Con version to an open operation should be employed when inflammation or p erforation occurs at the base of the appendix and when bowel is found to be adherent to an appendiceal abscess.