Laparoscopic accuracy in prediction of appendiceal pathology: Oncologic and inflammatory aspects

Background In the prelaparoscopy era, macroscopically normal appendices were routinely resected. The aim of this study was to evaluate the accuracy of laparoscopy. Methods A review of 1,899 patients who underwent appendectomy with multivariate analysis was conducted. Results Laparoscopic and open approaches had similar false-positive rates, false-negative rates, accuracy, and sensitivity. The study population included 17 false-negative cases (11% of all macroscopically normal appendices). Tumors were found in 1.1% of our study population. Female gender (1.9% vs.5%; odds ratio, 4; 95% confidence interval, 1.5 to 11; P <.005) and appendiceal perforation were independent risk factors for harboring a tumor. Conclusions It is suggested that laparoscopy has diagnostic quality similar to that of the open approach. Until randomized trials evaluate the fate of patients who receive false-negative diagnoses, routine appendectomy is recommended. Special attention should be paid to female patients and to patients with perforations, who have a 4-fold increased risk for harboring a tumor.