Randomized clinical trial evaluating elective laparoscopic appendicectomy for chronic right lower-quadrant pain

Abstract

It is questionable whether elective appendicectomy can effectively reduce persistent or recurrent right lower-quadrant abdominal pain due to chronic or recurrent appendicitis. This single-centre double-blind randomized clinical trial studied the effects of elective laparoscopic appendicectomy on pain 6 months after operation in patients with persistent or recurrent lower-quadrant pain. A secondary outcome evaluated was the relationship between clinical response and appendiceal histopathology. The analysis was performed on an intention-to-treat basis. Forty patients were randomized to laparoscopic appendicectomy (18) or laparoscopic inspection only (22). Postoperative pain scores differed significantly between the groups, favouring appendicectomy (P = 0.005). Relative risk calculations indicated that there was a 2.4 (95 per cent confidence interval (c.i.) 1.3 to 4.0) times greater chance of improvement in pain after laparoscopic appendicectomy. The number needed to treat was 2.2 (95 per cent c.i. 1.5 to 6.5). There was no association between postoperative pain scores and histopathology findings. Persistent or recurrent lower abdominal pain can be treated by elective appendicectomy with significant pain reduction in properly selected cases. Histopathology may not be abnormal. ISRCTN48831122 (http://www.controlled-trials.com).