Laparoscopy reduces unnecessary appendicectomies and improves diagnosis in fertile women. A randomized study. Laparoscopic versus open surgical exploration in premenopausal women with suspected acute appendicitis. The utility of laparoscopy in the diagnosis of acute appendicitis in women of reproductive age. A quality of life comparison of laparoscopic and open approaches in acute appendicitis: a randomised prospective study. Laparoscopic appendectomy-is it worthwhile? A prospective, randomized study in young women. Diagnostic laparoscopy reduces unnecessary appendicectomy in fertile women. [Laparoscopic appendectomy versus open appendectomy in suspected acute appendicitis in female patients]. Laparoscopic versus open appendectomy: prospective randomized trial. Laparoscopic appendectomy: differences between male and female patients with suspected acute appendicitis. Laparoscopy not recommended for routine appendectomy in men: results of a prospective randomized study. Randomized study of the value of laparoscopy before appendicectomy.
The aim of this study was to study the value of diagnostic laparoscopy prospectively in fertile women scheduled for acute appendectomy.
                For this study, 110 women, with acute abdominal pain ages 15 to 47 years, in whom the surgeon had decided to perform an appendectomy, were randomized to either open appendectomy or diagnostic laparoscopy, then open appendectomy if necessary.
                Appendicitis was diagnosed in 66% of the women after open surgery, and in 73% after laparoscopy. During laparoscopy, was appendicitis misdiagnosed in only 7% of the women, from whom the appendix unnecessarily removed, whereas 34% in the open surgery group had a healthy appendix removed. No appendicitis was missed in the laparoscopic group. The relative risk of removing a healthy appendix in open surgery was 6.6 relative risk (range, 2-21 C.I.) as compared with laparoscopy. Among the women with a healthy appendix, a gynecologic diagnosis was found in 73% after laparoscopy, as compared with 17% after open surgery.
                Laparoscopy reduces unnecessary appendectomies and improves diagnosis in fertile women. To assess the utility of laparoscopic versus conventional surgical exploration in premenopausal women with suspected acute appendicitis.
                Female patients aged 15-45 years in whom an independent decision to undertake surgical exploration had been made, were randomised to laparoscopic or open procedures. Comparison of patient groups was conducted on an intention-to-treat basis.
                Eighteen patients underwent laparoscopic exploration, with 1 procedure requiring conversion to lower midline laparotomy. Open surgical exploration was performed primarily in 16 patients. Postoperative complications (3 patients versus 1 patient) and diagnostic errors (5 patients versus 1 patient) were more frequent in patients undergoing open surgical procedures. Laparoscopic procedures tended to be of longer duration than open operations, but were generally associated with slightly more favourable indices of postoperative recovery (analgesic requirement, postoperative hospitalisation, return to normal activity, return to work). In patients found not to have acute appendicitis, the difference in mean postoperative hospitalisation following laparoscopic intervention (2.6 days) and conventional surgery (3.4 days) approached statistical significance (p < 0.1).
                Laparoscopy may carry some diagnostic advantage over open surgery in premenopausal women with suspected acute appendicitis. Patients found not to have acute appendicitis have a marginally shorter period of hospitalisation after laparoscopic intervention. The outcome following laparoscopic appendicectomy for confirmed acute appendicitis is at least equivalent to that achieved with conventional appendicectomy. Laparoscopic exploration is an acceptable option in premonopausal women requiring surgery for suspected acute appendicitis. To see whether laparoscopy improves the accuracy of a clinical diagnosis of acute appendicitis in women of reproductive age, and to determine what the long-term sequelae are of not removing an appendix deemed at laparoscopy to be normal.
                The initial part of the study was undertaken during 1991-1992. Female patients between 16 and 45 years were eligible for inclusion once a clinical decision had been made to perform an appendicectomy for suspected acute appendicitis. Following consent, patients were randomized into two groups. One group had open appendicectomy, as planned. The other group had laparoscopy, followed by open appendicectomy only if the appendix was seen to be inflamed or was not visualized. The end points for the study were the clinical outcomes of all patients, and the results of histology, where appropriate. An attempt was made to contact all patients at 10 years to determine whether they had had a subsequent appendicectomy, or had been diagnosed with another abdominal condition that might be relevant to the initial presentation in 1991-1992.
                Laparoscopic assessment was correct in all cases in which the appendix was visualized. Diagnostic accuracy was improved from 75% to 97%. Laparoscopy was associated with no added complications, no increase in hospital stay in patients who went on to appendicectomy, and a reduction in hospital stay for those who underwent laparoscopy alone. No patients developed a problem over the 10-year follow-up period from having a normal-looking appendix not removed at laparoscopy.
                Laparoscopic assessment of the appendix is reliable, and to leave a normal-looking appendix at laparoscopy does not appear to cause any long-term problems. The study aimed to evaluate the utility of a laparoscopic approach in the management of patients with right lower abdominal pain and in the quality of life after the operation.
                Patients with suspected appendicitis were included in the study. They were randomly assigned either to treatment with a traditional open approach or with a laparoscopic approach. The patients' data, including demographic data, complications and gastro-intestinal quality of life index scores, were collected at the 6th week and 6th month and compared between the groups.
                Overall, 83 appendectomies were performed. Other pathologies were ovulation bleeding, ovarian cyst, Meckel's diverticulum, ectopic pregnancy and leiomyoma of the uterus. Negative appendectomy rate was 7%. Severe infection occurred in five of the open group. The advantages of the laparoscopy also showed significantly in hospital stay (55.80 +/- 20.97 hours vs. 75.06 +/- 35.14 hours), the need for narcotics and in visual analog score, as well as in the gastrointestinal quality of life index (85.88 +/- 9.73 vs 101.30 +/- 9.31). The quality of life is still better in the long-term (95.14 +/- 8.45 vs 120.36 +/- 10.25). When the groups were compared according to the subgroups of gastro-intestinal quality of life index, except for disease-specific items, in all categories a significant improvement was seen in the laparoscopically treated patients. This improvement was observed in the follow-up period also. However, the hospital costs (987.50 +/- 77.25 USD vs. 406.27 +/- 100.59 USD) and operative time (56.25 +/- 10.9 vs. 49.41 +/- 11.76 minutes) still continued to be a problem for the laparoscopic group.
                Laparoscopic appendectomy is a safe method, which also has advantages of diagnostic procedure for other pathologies, a better quality of life both in the early and late period, and a short hospital stay. The important advantage is also seen in the late period with better quality of life. Clinical diagnosis of acute appendicitis is most difficult in fertile-age women. In this patient group up to 50% of open appendectomies are negative for appendicitis. We conducted a randomized study to compare laparoscopic and open appendectomy in young female patients with suspected acute appendicitis.
                Fifty female patients between the ages of 16 and 40 years presenting with acute right lower abdominal pain were randomized, 25 to laparoscopy and 25 to an open appendectomy. Diagnostic accuracy, rate of negative appendectomies, safety, and final outcome were compared in the two groups.
                Diagnosis was established in 96% of patients in the laparoscopic group and in 72% in the open group. There were 11 (44%) unnecessary appendectomies in the open group, but only one (4%) in the laparoscopic group (p < 0.0005).
                In young women with right lower abdominal pain, laparoscopy can give precise diagnosis and reduce the rate of negative appendectomies. To assess the value of laparoscopy in the accurate diagnosis of appendicitis in women of child-bearing age.
                Prospective randomised trial.
                University hospital, Kuwait.
                100 patients who fulfilled the inclusion criteria between July 1988 and March 1990.
                50 patients were randomised to have diagnostic laparoscopy followed by appendicectomy if necessary, and the other 50 to have immediate appendicectomy.
                Avoidance of unnecessary appendicectomy, length of operating time, and length of stay in hospital.
                19 of 50 patients in the study group did not require appendicectomy (38%). One patient required an emergency operation for an ectopic pregnancy. Of the remaining 30, only 4 of the removed appendixes showed no histological abnormality (13%). There were no complications of laparoscopy.
                Laparoscopy is a safe and effective way of diagnosing acute appendicitis and should be used more often. The aim of the study is to analyse the own data and try to discuss if laparoscopic appendectomy offers any advantages in treating young women suffering from pain in right lower abfdominal quadrant.
                The study was conducted on 148 patients admitted from October 1993 to December 1998 with diagnosis of of pain in right iliac fossa and operated on with a laparoscopic (LA group: 75 cases) or open approach (OA group: 73 cases). Patients were prospectively randomized on the surgical approach adopted, following a randomized list.
                The operative time in LA group was significantly (p < 0.001) longer (87.2 minutes) than for OA group (65.2 minutes). In 2 patients (2.7%) the operation had to be converted. Diagnosis had remained unknown in 16 patients (21.9%) of OA group, in spite of only one case (1.4%) with laparoscopic technique. We didn't observed intraoperative complications. Pain in the first and second postoperative days, evaluated on the use of pain medication, was significantly less in patients in group LA (p < 0.01). There were no deaths. Postoperative complications occurred in 4 patients (5.5%) of group LA, and in 8 patients (10.9%) of group OA. Hospital stay was significantly shorter for those having laparoscopic appendectomy (p < 0.001).
                The main advantages of laparoscopic appendectomy consist more in diagnostic accuracy, than in less postoperative pain, less hospital stay and less postoperative complications.
                Laparoscopic appendectomy is a safe and accurate approach. A prospective randomized trial comparing laparoscopic appendectomy with open appendectomy in patients with a diagnosis of acute appendicitis was conducted between October 1992 and April 1994. Of the 158 patients randomized, 7 patients were excluded because of protocol violations (conversion to laparotomy in 4, appendix not removed in 3). The 151 patients randomized to either a laparoscopic (n = 79) or an open appendectomy (n = 72) showed no difference in sex, age, American Society of Anesthesiology (ASA) rating, or previous abdominal surgery. The histologic classification of normal, catarrhal, inflamed, suppurative, and gangrenous appendicitis was not different between the two groups. Conversion from laparoscopic to open appendectomy was necessary in seven patients (9%) who had advanced forms of appendiceal inflammation. When compared to open appendectomy the laparoscopic group had a longer median operating time (63 minutes versus 40 minutes), fewer wound infections (2% versus 11%), less requirement for narcotic analgesia, and an earlier return to normal activity (median 7 days versus 14 days). There was no difference in morbidity, and both groups had a median time to discharge of 3 days. Laparoscopic appendectomy is as safe as open appendectomy; and despite the longer operating time, the advantages such as fewer wound infections and earlier return to normal activity make it a worthwhile alternative for patients with a clinical diagnosis of acute appendicitis. The role of laparoscopy in the management of patients with suspected acute appendicitis remains controversial. It has been suggested that laparoscopy is useful mainly in young women of reproductive age because of the high incidence of wrong diagnosis in these patients.
                Different management protocols for patients with suspected acute appendicitis were prospectively used in male and female patients; women of reproductive age were treated laparoscopically, while men were randomised to open or laparoscopic appendectomy.
                From September 2002 to September 2005, 132 patients-54 women and 78 men-with suspected acute appendicitis were treated according to the protocol. The incidence of wrong diagnosis in female patients was high (26% and the conversion rate low (5.5%). In contrast, in the laparoscopic male subgroup, these rates showed a reverse relationship (5.2% and 18.5%, respectively). Morbidity did not differ between female and male patients or between the 2 arms of the male group. Laparoscopic appendectomy took longer to perform without affecting significantly the needs for postoperative analgesia, the duration of hospital stay and the time to return to normal activities when compared with open appendectomy in men.
                Laparoscopic appendectomy is at least as safe as the open procedure in the male population, although it does not appear to offer any obvious advantage over the open procedure. The diagnostic advantage that laparoscopy offers to fertile women makes the procedure attractive for this population. Laparoscopic appendectomy has now gained wider acceptance in clinical practice, particularly in the treatment of women with right iliac fossa pain. However, the precise role of laparoscopic appendectomy in men is unclear, and this study was therefore undertaken to examine this specific issue in a prospective randomized trial.
                One hundred men between the ages of 16 and 65 years who had suspected appendicitis were recruited and randomized to undergo either open or laparoscopic appendectomy. Both groups were compared in terms of their clinical parameters, duration of anesthetic and operation times, postoperative pain, duration of ileus, and length of hospital stay.
                The histologic confirmation of appendicitis was present in 94% of the cases for both groups of patients. Laparoscopic appendectomy required significantly longer anesthetic time (72.5 minutes versus 55 minutes) and actual operating time (45 minutes versus 25 minutes) compared with open appendectomy. Postoperative pain as measured by visual analog scale on postoperative days 1 and 2 were not significantly different between the patients who underwent laparoscopic and open surgery with values of 4.7 versus 4.4 and 2.1 versus 2.2, respectively. Also no significant difference was seen between the laparoscopic and open appendectomy groups in the recovery of bowel function (24.7 hours versus 21 hours) and in the length of hospital stay (4.9 days versus 5.3 days).
                The results of this prospective randomized trial showed that there were no significant advantages of laparoscopic appendectomy over open appendectomy for the treatment of male patients with suspected appendicitis. We recommend that the use of laparoscopy be limited to men with atypical pain of uncertain diagnosis and in obese patients. Two groups of 30 women with clinical signs of appendicitis were randomized to immediate appendicectomy or diagnostic laparoscopy. In the latter group, appendicectomy was performed if a diagnosis of acute appendicitis was established or if the appendix could not be visualized. Eleven patients undergoing immediate operation had unnecessary appendicectomy, compared with two having laparoscopy. This difference of 30 per cent (95 per cent confidence interval 11-49 per cent) was significant (P = 0.01). There was no significant difference in postoperative morbidity rate in the two groups. Diagnostic laparoscopy is a useful preliminary investigation in women with clinical signs of acute appendicitis.
The advantages of laparoscopy in women with nonspecific abdominal pain and suspected appendicitis include a higher rate of specific diagnoses being made and a lower rate of removal of normal appendices compared to open appendicectomy only. Hospital stays were shorter. There was no evidence of an increase in adverse events with any of the strategies.