INCIDENTAL LAPAROSCOPIC APPENDECTOMY FOR ACUTE RIGHT LOWER QUADRANT ABDOMINAL-PAIN - ITS TIME HAS COME

Background: Removing the normal appendix when operating for suspected acute appendicitis is the standard of care. The use of laparoscopy sho uld not alter this practice. Methods: Retrospective review of 72 patie nts found to have grossly normal appendices while undergoing laparosco py for suspected appendicitis. Twenty-eight patients underwent diagnos tic laparoscopy (DL) alone while 44 patients underwent diagnostic lapa roscopy with incidental laparoscopic appendectomy (ILA). Results: Ther e was no difference in length of hospitalization (DL = 44 h, ILA = 43 h, p = 0.49) or morbidity (DL = 11%, ILA = 5%, p = 0.37). One patient required appendectomy 11 days after diagnostic laparoscopy for recurre nt acute right lower quadrant abdominal pain. Five percent of resected appendices (2/44) demonstrated acute inflammation upon pathologic rev iew. Conclusions: Laparoscopic removal of the normal appendix produces no added morbidity or increase in length of hospitalization as compar ed to diagnostic laparoscopy. It demonstrates cost effectiveness by pr eventing missed and future appendicitis. Incidental laparoscopic appen dectomy is the preferred treatment option.