Laparoscopy for Suspected Appendicitis in Children: May a Macroscopically Normal Appendix be Left In Situ?

Background/Purpose: An appendix which appears macroscopically normal is found in 10%-20% of laparoscopic explorations for suspected appendicitis. The appropriate surgical strategy for these cases is a matter of debate. We analysed a consecutive series of children in whom an inconspicuous appendix was left in situ. Material and Methods: Laparoscopic exploration was performed in 188 consecutive children with suspected appendicitis and an expected need for immediate operation from 2002 to 2006. Our concept included laparoscopic appendectomy in patients with macroscopic signs of inflammation. Normal appearing appendices were left in situ. All patients with a remaining appendix underwent follow-up. Major endpoints were defined as postoperative complications, re-operations for abdominal symptoms, hospital admissions and consultations with medical doctors during the follow-up period. In addition, other symptoms and well-being were assessed. Results: The appendix appeared macroscopically normal in 21 (11%) of the 188 patients (mean age 11.7 years (+/- 4.2); 11 f, 10 m), and was therefore left in situ. The immediate postoperative course was uneventful in all patients with a mean hospital stay of 2.7 (+/- 1.2) days. During the follow-up period (mean of 25 (+/- 17) months), 18 patients (86%) did not or only rarely (<= 2 times) consult a medical doctor for abdominal symptoms. Three patients (14%) reported more than 2 consultations. No patient was readmitted to hospital or operated for acute appendicitis. At the last follow-up, 20 patients (95%) were entirely symptom-free. One patient complained about persisting right lower quadrant pain, but refused further diagnostic procedures or interventions. Conclusion: According to our results, a macroscopically inconspicuous appendix may be left in situ in patients undergoing laparoscopy for suspected appendicitis. However, this conclusion is based on a small number of patients and larger series are mandatory.