Diagnostic laparoscopy in cases of suspected appendicitis: Does the appendix have to be removed?

Abstract

Purpose: The objective of this prospective study was to evaluate the efficacy of diagnostic laparoscopy in children with recurrent (chronic) unspecific abdominal pain as well as children with acute signs of appendicitis, leaving the appendix in situ when there were no visible signs of infection. Patients and Methods: In the last 5 years, we performed 170 laparoscopic appendectomies. In addition, we left the appendix in situ in 24 girls (mean age 12.3 years) and 13 boys (8.8 years). Of these children, 23 underwent laparoscopy after recurrent (three or more) hospitalizations due to abdominal pain of unclear origin and 14 because of acute signs of appendicitis. In these 37 cases, a standard laparoscopy was performed using a 4.5-mm laparoscope and 3-mm instruments. The mean operation time was 28 minutes. Results: In 14 girls and 5 boys, we could not detect any pathological findings. In 10 girls, we verified para-ovarian or ovarian cysts and adhesions, which were treated laparoscopically. In the 8 boys, adhesions and elongated sigmoid colon were detected and treated laparoscopically if appropriate. Of these 37 children, 32 have had no recurrent pain, and all were followed closely. Three girls had persisting pain within 1 year after laparoscopy. In one case the pain continues. However, this girl is under psychological treatment. A boy was operated on 1 year later with acute appendicitis. In our partner hospital, all children with suspected appendicitis underwent appendectomy. In 29 cases, additional pathology was found and treated when indicated. The mean operation time was 46 minutes. Nine patients continued having pain for more than 1 year after appendectomy. Conclusion: In our opinion, diagnostic laparoscopy in cases of suspected appendicitis should not automatically lead to an appendectomy, especially when additional findings might be the cause of pain.