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[Can we recognize the pathological character of the appendix during laparoscopy? Prospective study: 81 cases]
1Service de Chirurgie Générale et Digestive, Université Paris XIII, UFR de Médecine de Bobigny-Bondy, Hôpital Jean Verdier, Bondy.
Abstract:
In a prospective study of 81 patients, the appendix was photographed during a laparoscopy performed for pain in the right iliac fossa. An appendicectomy was performed in 65 patients, for the remaining 16, another cause for the pain was found and the appendix was left in place. The evaluation of the photographed appendix was formed afterwards by a group of 10 surgeons and compared with the histopathological results. In 20 cases (30%) the appendix was normal. In 7 (10%) minimal mucosal inflammation was found and in 38 (60%) acute appendicitis. All the surgeons correctly recognised acute appendicitis. The accuracy of recognition of a normal appendix was 70% overall, and the maximum risk of leaving an early form of appendicitis to evolve was 14%. We propose not removing an appendix judged to be normal during laparoscopy if no other cause for the pain is found. A short course of antibiotics would cover the low risk of allowing a very early appendicitis to develop.
Insights
Surgeons accurately identified acute appendicitis during laparoscopy. Leaving a visually normal appendix in place, with antibiotics, poses a low risk of missed early appendicitis.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Laparoscopic surgery is common for right iliac fossa pain.
- Accurate diagnosis of appendicitis during laparoscopy is crucial.
Purpose of the Study:
- To evaluate the accuracy of visual assessment of the appendix during laparoscopy.
- To determine the safety of not removing a visually normal appendix.
Main Methods:
- Prospective study of 81 patients undergoing laparoscopy for right iliac fossa pain.
- Appendix photographed during surgery; evaluated by 10 surgeons.
- Visual assessment compared with histopathological findings.
Main Results:
- Acute appendicitis diagnosed in 60% of surgically removed appendices.
- Surgeons correctly identified all cases of acute appendicitis.
- Visual assessment accuracy for normal appendix was 70%.
- Maximum risk of missing early appendicitis was 14%.
Conclusions:
- Visual assessment of the appendix during laparoscopy is highly accurate for acute appendicitis.
- Not removing a visually normal appendix is a safe strategy.
- Antibiotics can mitigate the low risk of developing early appendicitis.