GS29P LAPAROSCOPIC APPENDICECTOMY: TO DO OR NOT TO DO

Traditional teaching instructs us to remove a normal appendix during open appendicectomy, to avoid confusion during future presentations with right iliac fossa pain 1 . This ideology has been associated with a negative appendicectomy rate in the order of 15–20% 2 . The risk of missing submucosal appendicitis, of which the clinical significance remains unclear, has also propagated the decision to remove the ‘normal’ appendix. The advent of laparoscopy has lead to an improvement in the diagnosis of alternate pathology in the context of suspected appendicitis, particularly in the female population. There however still remains some confusion and concern amongst members of the surgical community as to whether appendicectomy should be performed in the context of normal other laparoscopic findings. We present the results of a retrospective review of 400 patients who underwent laparoscopy (+/− appendicectomy) at Westmead Hospital (Sydney, Australia) from July 2004 to June 2006 for suspected appendicitis, or for the investigation of right iliac fossa pain. Follow‐up ranged from 6 months to 2.5 years. Of the 200 patients reviewed to date, in the 120 patients who underwent laparoscopy, 84% proceeded to have appendicectomies despite normal operative findings in one third of cases. This led to a high negative appendicectomy rate of 34%. In our experience, removal of the appendix is not justified when the appendix appears normal at laparoscopy, even in the absence of alternate pathology.