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Elective laparoscopic appendectomy in patients with familial Mediterranean fever
P Reissman1, A L Durst, A Rivkind
1Department of General Surgery, Hadassah University Hospital, Jerusalem, Israel.
Abstract:
Familial Mediterranean fever (FMF) also known as hereditary polyserositis, is an inherited disorder commonly found in Armenians, Turks, Arabs, Balkans, and Jews originating from North African countries. The diagnosis of FMF is based on clinical findings and family history, as no specific diagnostic test is yet available. One of its main clinical features is recurrent acute episodes of peritonitis. During such an episode, physical examination and laboratory findings may be similar to those for acute appendicitis. Therefore up to two-thirds of FMF patients undergo emergency appendectomy, with the appendix being normal in most cases. As laparoscopic appendectomy has proved to be safe and advantageous, and to prevent misdiagnosis and unnecessary emergency surgery, we performed elective laparoscopic appendectomy in 13 FMF patients ranging in age from 8 to 32 years. They had been suffering from the disease for 1 to 12 years (mean 3.8) and had had an average of 3.5 yearly episodes of FMF peritonitis. All procedures were concluded by laparoscopy without conversion to open surgery. The average postoperative hospital stay was 3.07 days. The only complication was superficial wound infection in one patient (7.6%), and the mean time to regain full normal activity was 8.5 days. We conclude that elective laparoscopic appendectomy in FMF patients is safe. It helps to exclude appendicitis as a cause for peritonitis in these patients and may prevent unnecessary emergency surgery.
Insights
Familial Mediterranean fever (FMF) patients often undergo unnecessary appendectomies due to similar symptoms to appendicitis. Elective laparoscopic appendectomy in FMF patients is a safe procedure to rule out appendicitis and prevent misdiagnosis.
Area of Science:
- Gastroenterology
- Genetics
- Surgical Procedures
Background:
- Familial Mediterranean fever (FMF), or hereditary polyserositis, is an inherited disorder prevalent in specific ethnic groups.
- FMF diagnosis relies on clinical findings and family history, lacking a definitive diagnostic test.
- Recurrent peritonitis is a key FMF symptom, often mimicking acute appendicitis, leading to frequent, unnecessary appendectomies.
Purpose of the Study:
- To evaluate the safety and efficacy of elective laparoscopic appendectomy in patients diagnosed with Familial Mediterranean fever (FMF).
- To determine if this surgical approach can prevent misdiagnosis and unnecessary emergency surgeries in FMF patients presenting with peritonitis.
Main Methods:
- Elective laparoscopic appendectomy was performed on 13 FMF patients aged 8-32 years.
- Patients had a history of FMF peritonitis (1-12 years duration, average 3.5 episodes/year).
- All procedures were completed laparoscopically without conversion to open surgery.
Main Results:
- The average postoperative hospital stay was 3.07 days.
- One patient (7.6%) experienced a superficial wound infection, the only complication.
- Full recovery averaged 8.5 days post-surgery.
Conclusions:
- Elective laparoscopic appendectomy is a safe procedure for FMF patients.
- This surgical intervention effectively rules out appendicitis as a cause of peritonitis in FMF patients.
- The procedure can prevent unnecessary emergency surgeries and misdiagnoses in this patient population.