Reducing the negative appendectomy rate with the laparoscopic appendicitis score; a multicenter prospective cohort...

Area of Science:

• Surgical Innovation
• Diagnostic Accuracy
• Appendicitis Management

Background:

• Approximately 9% of appendectomies are performed on normal appendices, leading to increased morbidity and mortality.
• The Laparoscopic APPendicitis (LAPP) score was developed to systematically evaluate the appendix for inflammation.
• Current diagnostic methods for appendicitis carry risks of negative appendectomy or missed appendicitis.

Purpose of the Study:

• To determine if the LAPP score can reduce the negative appendectomy rate.
• To assess if the LAPP score accurately identifies appendicitis, avoiding missed diagnoses.
• To validate the LAPP score in a multicenter prospective study.

Main Methods:

• A prospective validation study included 322 adult patients with suspected appendicitis undergoing diagnostic laparoscopy (September 2013 - May 2016).
• Patients were divided into groups based on LAPP score: appendix removed (n=300) or left in situ (n=22).
• Comparison was made to a historical control group of 584 patients; pathological examination confirmed diagnoses and calculated negative appendectomy rates.

Main Results:

• The negative appendectomy rate was significantly lower with the LAPP score (4.7% vs. 8.4%, P=0.034).
• No patients with a negative LAPP score and appendix left in situ developed appendicitis within three months.
• LAPP score use correlated with increased preoperative radiological imaging (98% vs. 70%, P<0.001) and fewer treatment failures (OR: 0.48, P=0.025).

Conclusions:

• The LAPP score is a safe and simple tool for reducing negative appendectomies during laparoscopic surgery.
• The LAPP score effectively avoids missing cases of acute appendicitis.
• Implementation of the LAPP score improves diagnostic accuracy in appendicitis management.