Background: Laparoscopy has been used to diagnose and treat appendicitis. Its use in females in the reproductive ages might be more valuable to diagnose and treat the mimicking conditions.
Objective: To determine the value of the use of laparoscopy in females in the reproductive ages suspicious for acute appendicitis.
Patients and methods: Sixty female patients in the child-bearing ages (study group), who were suspicious for acute appendicitis, were evaluated by laparoscopy. They were compared with retrospectively assigned 280 female patients (control group) with comparable demographic characters, who were explored for appendectomy by the usual surgical method. Both groups were compared for the clinical picture, results of investigations, operative findings and outcome.
Results: The duration between the onset of symptoms and operative intervention was significantly shorter in the study group (18±6 vs. 29±8, p<0.001). Atypical presentation was present in 48%, disproportionate tachycardia in 11% and rebound tenderness in 77% of cases in both groups. Vaginal examination showed tenderness on moving the cervix in 42% of cases in the study group. Leucocytosis was present in all cases with shift to the left in 95 % and elevated erythrocyte sedimentation rate in >73% of cases in both groups. Abdominal ultrasonography was not conclusive while trans-vaginal ultrasonography was suggesting pathology in about 29% of the examined cases in the study group. Operative findings confirmed the diagnosis of appendicitis in only 70% in both groups, where appendectomy was done by laparoscopy in 94.2% of cases in the study group and by the usual surgical method in the control group. Complicated functional right-sided ovarian cystic changes were present in 20% of cases in both groups, where laparoscopic cystectomy was done in the study group while oophorectomy by the usual surgical method was done in the control group. Appendicular mass was present in only 2/60 and 10/280, PID in 2/60 and 9/280, torsed small right subserous myoma in 1/60 and 3/280 of both groups respectively. Pelvic position of the appendix was present in 29% of cases and normal operative findings were detected in 1/60 and 6/280 of both groups respectively. The mean length of the operation was comparable for both groups. The mean hospital stay was significantly shorter in the study group (p<0.001). There was no significant difference between both groups for the readmission rate and overall complications. Return to normal activity was significantly earlier in the study group (p<0.01).
Conclusions: Laparoscopic evaluation of females in the childbearing ages suspicious for acute appendicitis by a gynecologist and a general surgeon simultaneously seems to be more beneficial for accurate diagnosis and proper treatment, both for the appendicitis and the mimicking conditions.
Recommendations: Females in the childbearing ages suspicious for acute appendicitis should be evaluated by laparoscopy simultaneously by a gynecologist and a general surgeon.
Key words: Acute appendicitis, laparoscopy, functional ovarian cysts.