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Examination under anesthesia prior laparoscopic appendicectomy: does it change the approach?
Saleh Abbas1, Alex Ng, Wayne Jones
1Auckland Hospital, Park Road, Grafton, Auckland, New Zealand. salehabbas@yahoo.com
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
|February 24, 2007
Summary
Examination under anesthesia is crucial for acute appendicitis cases with a palpable mass. If a mass is detected, converting from laparoscopic to open appendicectomy is recommended for better outcomes.
Area of Science:
- Surgery
- Gastroenterology
Background:
- A palpable mass in the right iliac fossa can complicate acute appendicitis diagnosis and management.
- Examination under anesthesia (EUA) may reveal masses not evident during standard physical examination.
Purpose of the Study:
- To evaluate the significance of EUA in patients with suspected acute appendicitis.
- To analyze the outcomes of laparoscopic appendicectomy in relation to masses detected by EUA.
Main Methods:
- Prospective study of 179 patients undergoing laparoscopic appendicectomy over 12 months.
- Correlation of intraoperative findings and conversion rates with pre-operative EUA findings.
Main Results:
- A mass palpable only under anesthesia was found in 20 patients (11%).
- Conversion to open appendicectomy was significantly higher in patients with a palpable mass (65%) compared to those without (4%) (P<0.0001).
Conclusions:
- EUA is valuable in identifying masses associated with acute appendicitis.
- Laparoscopic appendicectomy for acute appendicitis with a mass detected by EUA should be converted to open surgery proactively.
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