Laparoscopic appendectomy: a new opportunity for curing appendicopathy

It is strongly disputed whether the appendix is indeed the cause of chronic abdominal complaints, even when the pain is situated in the right lower quadrant. In 1976 the introduction of a new operative technique, the laparoscopic appendectomy, offered new insight by making it possible to remove an appendix that is not acutely inflamed through a second insertion in the right lower quadrant by using the open stump method. Between 1976 and 1989, this operation was performed on 1,214 patients in a regional population of about 75,000 people and was successfully performed in 85%. Two subgroups totaling 215 patients showed a success rate of greater than 80% with no major complications; after one year, the patients' scars were almost invisible. This high success rate of a somatic therapy for a so-called psychosomatic disease can be explained by the following possible pathological changes in the appendix: corpora aliena, parasites, kinking, adhesions, obliterations, viral follicular hypertrophy, fibrosis, and neural changes. Most of these conditions are postinfectious. The greater ability of female patients to handle infection results in differences between the two sexes in frequency, development, and behavior of the disease. Laparoscopy alone can reveal a herd of pathologic conditions in patients with pain of unknown origin. With the aid of the laparoscope, appendectomy can be added safely and more patients relieved from chronic abdominal complaints than previously thought possible.