Management of the Normal Appendix during Laparoscopy for Right Iliac Fossa Pain

Abstract

questions whether there is progression to suppurative appendicitis.7 Many patients are unsure as to whether their appendix has been removed. Murphy et al 2001 reported that of 176 patients who had laparoscopy for right iliac fossa pain 61% were under the misapprehension that their appendix had been removed.9 They suggest that the removal of a normal appendix adds little to the morbidity of laparoscopy and that the appendix should be removed regardless of its appearance at laparoscopy.10 This is supported by studies where incidental appendicectomy has been performed during total abdominal hysterectomy11 and cystectomy.12 However other studies report increased complications following the removal of a normal appendix.13-17 Data on follow-up of patients who have not had their appendix removed suggest that it is safe to leave a normal appendix in place. Van den Broek et al 2000 reported a prospective study of 109 diagnostic laparoscopies for suspected appendicitis where the appendix was left in place if it looked normal. There were 9 readmissions with only one requiring an appendicectomy.18 Van Dalen et al 2003 reported a prospective randomised study of 63 patients with 10 years follow-up. Patients found at laparoscopy to have a normal appearing appendix were randomised to laparoscopy + open appendicectomy or laparoscopy only. No patients in the diagnostic laparoscopy group developed appendicitis subsequently.19 Teh et al 2000 reported that of 41 patients who had laparoscopy alone for a normal appendix 13 continued to have symptoms and 2 eventually had their normal appendix removed.20 In this study we assess the practice of members of ALSGBI and their views on whether guidelines are desirable.