Prediction of inflammation of the appendix at open and laparoscopic appendicectomy: findings and consequences

To evaluate the accuracy of operative assessment of the condition of the appendix during laparoscopic and open appendicectomy, and to assess whether a normal-looking appendix should be excised routinely during a laparoscopic operation.

Prospective study.

District general hospital, UK.

387 patients who presented with signs and symptoms of appendicitis and underwent appendicectomy.

63 patients (16%) were operated on laparoscopically, of whom 48 were female.

Correlation of operative with histological findings.

The positive predictive value of operative assessment was increased during the laparoscopic procedure in both male (94.4% to 100%) and female (78% to 88%) patients. Of 21 female patients whose appendixes looked normal at laparoscopy, 5 had other conditions (appendixes normal on histological examination) and 4 were inflamed.

In women of childbearing age a normal-looking appendix should be resected during laparoscopic appendicectomy unless another condition is obviously the cause of the signs and symptoms.