Introducing diagnostic laparoscopy for patients with suspected acute appendicitis

Background: The diagnostic accuracy in patients with suspected acute append icitis varies from 60% to 90% depending on age and gender. The aim of this study was to evaluate the use of diagnostic laparoscopy for diagnostic purp oses in patients with suspected acute appendicitis to prevent unnecessary l aparotomy and to leave a macroscopically normal appendix in place. Methods: For this study, 500 consecutive patients with suspected acute appe ndicitis admitted between January 1994 and October 1996 were included prosp ectively in a surgical training program set to provide diagnostic laparosco py on a 24-h-a-day basis. Primary open operation was performed when no lapa roscopically trained surgeon was available. Short-term outcome measurements were recorded, and a retrospective long-term follow-up evaluation was perf ormed. Results: We succeeded in performing a diagnostic laparoscopy in 376 patient s and a primary open operation in 124 patients. The overall appendicitis ra te was 78%. A diagnostic laparoscopy alone was performed in 66 patients (56 of which were fertile women), with a median operating time of 36 min and a complication rate of 0%. The overall complication rate was 8.0%. During a median follow-up period of 19 months one patient returned on a later occasi on with appendicitis. At completion of the study, 85% of the surgeons were skilled in diagnostic laparoscopy. Conclusions: Substantial education effort is needed to introduce diagnostic laparoscopy on a 24-h-a-day basis. Diagnostic laparoscopy has a high rate of accuracy, short operating time, and low associated morbidity, and preven ts unnecessary laparotomy. It is possible to leave a macroscopically normal -appearing appendix in place.