Value of microlaparoscopy in the diagnosis of right iliac fossa pain

The possibility of performing minimally invasive exploration of the abdomen could avoid unnecessary appendectomies. Micro-optics and instruments of 2 mm in diameter allow this type of exploration, but the feasibility and the accuracy of the diagnosis resulting from this method have not been evaluated.

A prospective study of 36 patients (11 men and 25 women) operated on for acute right iliac fossa pain was carried out. The abdomen was explored with a 2 mm optic and with a 10 mm optic in order to characterize the aspect of the appendix. The results were compared with the postoperative pathologic findings of the appendix.

The micro-optic procedure failed in 3 patients. The appendix was visualized in 26 patients: in 18 patients through the needle-optic alone, 8 patients requiring additional instruments. The appendix was visualized in all cases with the 10 mm optic. Appendectomy was performed in 34 patients: with microinstruments in 6, with 5 mm instruments in 26, and through a MacBurney incision in 2. The appendix was not removed in 2 patients. A correct diagnosis was made by microlaparoscopy and confirmed by the pathology in 21 patients (58%), made and confirmed in 32 patients with a 10 mm optic (89%). Minor complications included a cecal wall insufflation in 1 patient and a peroperative hemorrhage on a 2 mm port site in another with an uneventful postoperative course. One postoperative parietal hematoma required reoperating removal. No mortality was observed.

The low quality of the image obtained with microlaparoscopy does not permit safely evaluating the aspect of the appendix in case of acute right iliac pain. This method is not recommended for routine abdominal exploration.