Macroscopic assessment of the appendix at diagnostic laparoscopy is reliable

Background: Healthy-looking appendixes are often removed at laparoscopy for suspected appendicitis. This practice may have adverse secondary effects. Methods: We reviewed the literature for the years 1978 to 1998 to analyze t he negative appendectomy rates, complication rates, the accuracy of laparos copic appendix assessment, and the incidence of false negative diagnosis of appendicitis at surgical and gynecological laparoscopy. Results: The respective negative appendectomy rates were 22% and 15% in stu dies that compared laparoscopic with open appendectomy. The appendix was le ft in situ in 37% of 4,281 surgical diagnostic laparoscopies. There were in stances of missed appendicitis among the 3,367 gynecological diagnostic lap aroscopies performed on women for lower abdominal pain, and there were 188 appendectomies in this group. Studies comparing the macroscopic appearance of the appendix at operation with microscopic findings from the excised spe cimen had a false negative error rate of 3%. Conclusions: Contrary to general opinion, there is no substantial evidence to support the assumption that the macroscopic diagnosis of appendicitis is unreliable. High rates of conflicting diagnoses of excision specimens sugg est that endoappendicitis has little clinical significance. At present, neg ative appendectomy rates are considerably higher for laparoscopic appendect omy than for the open approach. The role of diagnostic laparoscopy in suspe cted appendicitis should be reconsidered. It may be useful in particular su bgroups of patients, but it is no substitute for good clinical judgment. Fu rthermore, it is not always necessary to perform an incidental appendectomy .