ABSTRACT
In this prospective randomized study, we investigated the value of laparoscopy in the diagnostic evaluation for possible appendicitis and its therapeutic efficacy when gynaecological conditions were encountered in 90 women of childbearing age. 85 laparoscopies [94.4%] were satisfactory where the entire appendix and pelvic viscera could be visualized, 58 were thought to have acute appendicitis, 16 salpingitis, 2 ruptured ovarian cyst, 2 adnexal torsion, one tuboovarian abscess, 2 mesenteric lymphadenitis and 4 were thought to have no pathological condition. Histological diagnosis confirmed acute appendicitis in 54 patients; 50 correctly diagnosed at the time of laparoscopy and 4 diagnosed at the time of laparotomy following unsatisfactory laparoscop. Salpingitis was finally diagnosed in 24 patients: 16 correctly diagnosed by the laparoscope and 8 were diagnosed retrospectively after removal of normal appendicies. Laparotomy was avoided by confirmation of non-surgical diagnosis in 22 patients [24.4% = negative laparotomy rate when laparoscopy was performed]. Sixteen of these patients were found to have acute salpingitis, 2 mesenteric lymphadenitis and 4 with no pathological finding. If laparotomy had been performed, the negative laparotomy rate would have been 33.3%. Successful laparoscopic procedures were achieved in all gynaecological conditions encountered. We conclude that diagnostic laparoscopy can reduce the negative laparotomy rate in premenopausal female patients presenting with suspected acute appendicitis and has a therapeutic capability when gynaecological conditions are faced