Does laparoscopy reduce the incidence of useless appendectomies?

The aim of this retrospective study is to evaluate the impact of laparoscop ic appendicectomy on the incidence of histologically normal appendices. Bet ween 1987 and 1997, 1220 consecutives patients - with an average age of 23. 5 years (17-73) and including 841 women (69 %)- underwent appendicectomy du e to the presence of at least one of the following 3 criteria: right iliac fossa guarding, fever greater than 38 degrees C and hyperleucocytosis great er than 10,000. Patients were divided into two group.: First group with 930 patients were operated by laparotomy and the other group of 355 patients u nderwent laparoscopic exploration with appendicectomy wheen macroscopic abn ormalities were observed (290 cases). In all cases, the appendices were exa mined under blind conditions and classified as normal or pathological, and were subsequently classified according to the nature and the severity of th e lesions. In group I (laparotomy), the incidence of histologically normal appendices was 25.1%. In group II(laparoscopic), this incidence was only 8. 2%. The difference was significant (p = 0.015). tn 65 cases (18.3%), a macr oscopically normal appendix was left in place: in 55 cases the symptoms wer e due to another identified cause, however, in 10 cases no cause was found. This study suggests that laparoscopy significantly reduces the number of h istologically normal appendices because an other cause is identified more e asily provided macroscopically normal appendices are not removed with a sma ll proportion (5-10 %) cases of early appendicitis with only mucosal involv ement. In the absence of other causes for the symptoms, a three-day course of antibiotics can be tried in order to treat possible mucosal lesions. Thi s approach reduces costs without having any adverse consequences on outcome .