Laparoscopic appendectomy after conservative management of appendix mass

The purpose of this study was to demonstrate the safety and efficacy of laparoscopic appendicectomy following non-operative management of appendix mass in children. Medical records of 103 consecutive patients (61 males, 42 females) who underwent non-operative treatment of appendix mass followed by laparoscopic elective appendicectomy were examined. Their ages ranged from 2 years 5 months to 15 years (mean 8.3 years). All patients were treated conservatively by close observation, antibiotics and intravenous fluids. Once the child was fit for discharge laparoscopic elective appendicectomy was booked for 4–6 weeks later. Ninety-three children responded to the initial conservative treatment and were discharged after a mean hospital stay of 5.6 days (range 3–10 days). Ten (9.7%) did not respond to initial treatment and developed appendix abscess requiring drainage. Average hospital stay in the 97 patients who had laparoscopic elective appendicectomy was 2.5 days (range 1–5 days). Three patients developed complications after elective appendicectomy, a stitch abscess in one, paralytic ileus in one and wound infection in one. Histological examination revealed fibrosed or resolving appendicitis in 52, acute or subacute appendicitis in 24, carcinoid tumour in two and normal appendix in 19. Laparoscopic elective appendicectomy is a safe and effective method of treatment following conservative treatment of appendix mass. Not only does it make the dissection and resection of the appendix easier but it also has the added advantage of performing adhesiolysis.     

Appendiceal mass in children

A total of 198 were diagnosed to have an appendiceal mass between 1982 and 1991;9 underwent appendicectomy immediately following diagnosis. One developed a wound infection. Of the remaining 189 patients 162 (85.7%) had unevenful resolution of the mass. The mean duration of hospital stay was 9.7 days. Twenty-seven patients failed to respond to initial non-operative management; 16 developed an appendix abscedd and required drainage. One patient had percutaneous drainage under ultrasound control. One of these 16 patients developed a wound infection after interval appendicectomy. Four other patients underwent appendicectomy during the initial admission because of clinical deterioration and all of them were found to have an appendix mass at operation. Three of these 4 patients developed postoperative complications (wound infection 1, intra-abdominal abscess 1, small-bowel obstruction 1). Seven other patients required admission and appendicectomy while waiting for interval appendicectomy. At operation, 5 still had an appendiceal mass/ abscess and 2 had acute appendicitis. The child with an appendiceal abscess continued to have a discharging wound for 19 days. All others, except 3 patients who were lost to follow-up, underwent interval appendicectomy. Mean duration of hospital stay for interval appendicectomy was 301 days. Two patients who did not return for elective appendicectomy developed acute appendicitis and required appendicectomy 65 days and 8 months after discharge. Three (1.9%) of 161 patients (all in the first half of the series) developed postoperative complications following interval appendicectomy (wound hematoma 1, wound infection 1. pneumonia 1). Evidence of inflammation was present on histological examination in 47.2% of the cases. These data support the belief that initial non-operative management of an appendiceal mass followed by interval appendicectomy is a safe and effective method of management.     

The effect of the availability of laparoscopic techniques on the treatment of appendicitis in children

 The use of laparoscopic surgery for acute appendicitis (AA) in children has increased over recent years. The aim of this study was to determine what effect the availability of laparoscopic appendicectomy (LA) has had on children admitted with suspected AA. A retrospective review of children admitted between January 1994 and June 1999 inclusive who underwent appendicectomy for suspected AA was conducted. Data recorded included standard demographic information, surgical approach, histopathology of the appendix, complications, and post-operative length of stay. After LA, children had a shorter post-operative stay, although the technique was used less frequently in advanced disease. The rate of normal histology was higher for LA. Laparoscopic surgery was performed in females in 69% of whom 48% had a normal appendix removed. The duration of surgery was longer for LA (59 vs 40 min). The rate of LA increased to 77% in the first 6 months of 1999. There was a decrease in the proportion of laparoscopic procedures converted to open appendicectomy from 50 to 6% during the period reviewed. The ready availability of laparoscopy and increased confidence in its use has resulted in more children, especially females, with suspected AA undergoing laparoscopy. There was a corresponding higher rate of normal appendix removal in this group, but the overall rate of normal histology has not changed, suggesting that the laparoscopic approach is more likely to be employed where the clinical diagnosis is less certain, particularly in older girls. Accepted: 8 December 1999     

腹腔镜手术与开腹手术治疗儿童复杂性阑尾炎的疗效比较

目的对比分析腹腔镜阑尾切除术（1apamscopicappendectomy,LA）与开腹阑尾切除术（openappendectomy,OA）治疗儿童复杂阑尾炎的临床疗效。方法回顾性分析本院自2014年6月至2015年2月收治的45例儿童复杂阑尾炎患者临床资料,根据不同手术方式分为LA组和OA组,其中LA组21例,OA组24例,比较两组术中出血量、手术时间、术后肠功能恢复时间及住院时间、切口感染、腹腔脓肿及直肠刺激症状的发生率及留置腹腔引流的比率等。结果本组45例均痊愈。LA组手术时间（88．6±20．1）min,OA组手术时间（84．1±10．2）min,两组差异无统计学意义（P=0．340）。LA组有2例中转开腹手术。LA组术中出血（14±10．2）mL,术后肠功能恢复时间（32．6±12．3）h,住院时间（4．2±1．9）d,Troear孔感染率（4．8％）,直肠刺激症状发生率（9．5％）,置腹腔引流率（19．0％）,腹腔脓肿发生率（9．5％）。OA组术中出血（26±9．2）mL,术后肠功能恢复时间（50．6±19．2）h,住院时间（6．2±1．8）d,切口感染率（33．3％）,直肠刺激症状发生率（37．5％）,置腹腔引流率（75％）,腹腔脓肿发生率（37．5％）。两组上述指标比较,差异均有统计学意义（P值分别为：0．000,0．001,0．001,0．044,0．029,0．000,0．029。所有患儿术后随访4～12个月,无一例发生阑尾残株炎、肠瘘及粘连性肠梗阻等并发症。结论腹腔镜手术治疗儿童复杂阑尾炎,安全有效,术后并发症少,有利于患儿术后康复。     

Appendicular colic and the non-inflamed appendix: fact or fiction?

AIMS: Appendicoliths cause acute appendicitis and appendicular perforation. Do appendicoliths cause acute abdominal pain in the absence of acute appendicitis? METHODS: A retrospective observational study was undertaken of histology reports of all appendicectomy specimens from children < 16 years of age between January 1995 and December 2001. Specimens were categorised as perforated or uncomplicated acute appendicitis, non-inflamed, and "incidental" (removed during abdominal surgery for other indications). The presence of an appendicolith was noted. Clinical details were supplemented by selected case note review. Specimens in which the diagnosis of appendicitis or the presence of an appendicolith were not clearly defined (n = 20) were reviewed by an experienced, independent pathologist. RESULTS: 601 consecutive appendicectomy reports were analysed. The mean age of the study population was 9 years (range 1 day - 15.9 years) and there were 357 boys. An appendicolith was identified in 31/118 (26%) cases of perforated appendicitis, 60/352 (17%) cases of uncomplicated appendicitis, 12/59 (20%) cases of non-inflamed appendices, and only 1/72 (1%) cases of incidental appendicectomies. All patients with an appendicolith in the non-inflamed appendix group had presented with acute abdominal pain mimicking acute appendicitis. The frequency of an appendicolith in perforated appendicitis was significantly greater than in uncomplicated acute appendicitis (chi (2) = 4.8, 1 df, p < 0.05). There was no significant difference in the frequency of an appendicolith between non-inflamed appendices and acute appendicitis (either perforated or intact). Appendicoliths were rarely found in incidental appendicectomies, but these patients were younger. The frequency of appendicoliths in non-inflamed appendices was much greater than that expected from published autopsy data. CONCLUSION: Appendicoliths may cause acute abdominal pain that mimics acute appendicitis.     

Acute appendicitis: the continuing role for active observation

We present the results of a 6-year review of appendicitis. In the event of diagnostic doubt, a policy of active observation was instituted. This review endorses the validity of such a policy, indicating that it does not expose patients to increased morbidity. Data were collected prospectively over a 6-year period on 1,479 children admitted with suspected acute appendicitis (AA); 1,028 (69.5%) were discharged with a diagnosis of non-specific abdominal pain after a mean observation period of 2.5 days, whilst in the remaining 451 a clinical diagnosis of AA was confirmed. The male-to-female ratio was equal, with no difference in the mean age of males (11 years) or females (12 years); 95% of patients were over the age of 5 years. In 324 (72%) cases surgery was performed on the day of admission, whilst in the remaining 126 (28%) it was deferred for 1 to 6 days because the clinical diagnosis of AA remained doubtful. The mean hospital stay was 4 days (range 1 – 32). Analysis of the histological reports of all 451 cases confirmed a positive predictive value for clinical assessment alone of 97.9% and a normal appendicectomy rate of 2.6%. No mortality was observed; surgical morbidity was recorded at 6% with no correlation between post-operative morbidity and timing of surgery evident (Spearmans correlation coefficient = −0.079, p=0.9). Active observation for suspected AA thus remains a valid technique for achieving an accurate diagnosis and successful outcome. Accepted: 25 April 2000     

CT can reduce hospitalization for observation in children with suspected appendicitis

Background: There are no clinical or laboratory tests that can eliminate the possibility of appendicitis in a child with abdominal pain that suggests the diagnosis. The standard of care is to admit these children to the hospital for observation. More than twice as many children hospitalized for abdominal pain suggesting appendicitis are subsequently sent home after observation compared to those who undergo appendectomy. Objective: To evaluate the ability of CT with rectal contrast medium (CTRC) to diagnose a normal appendix in children with abdominal pain. Materials and methods: A prospective cohort study in an urban pediatric emergency department. Children 6–17 years of age with abdominal pain were eligible when the attending physician planned to admit them for observation for possible appendicitis. All 94 patients underwent CTRC. CTRC results were compared to patient outcomes. Results: Ninety-four children successfully underwent CTRC. Among the 53 patients with reflux of contrast medium into the ileum, the appendix was visualized in 43 (81.1%). Among all 94 cases, the appendix was visualized in 53 cases (55.7%); 43 studies were read as normal, and 10 showed appendicitis. Of the 43 with a normal appendix, 23 were discharged home, 18 were admitted but discharged uneventfully, and two underwent surgery for another diagnosis. When the appendix was visualized, the sensitivity, specificity, and negative and positive predictive values of CTRC were 100% (95% CI 66.4, 100.0), 97.7% (95% CI 88.0, 99.9), 100% (95% CI 91.8, 100.0), and 90% (95% CI 55.5, 99.8), respectively. The use of CTRC could have decreased the admission rate for observation for appendicitis by at least 41.8% and by more than 80% when the appendix could be seen. Conclusion: Our data suggest that when the appendix can be visualized, CTRC can accurately identify a normal appendix and reduce the number of children hospitalized for observation for possible appendicitis.Presented in part at the Pediatric Academic Societies annual meeting, Baltimore, Maryland, USA, May 2001     

Laparoscopic appendicectomy in childhood

Laparoscopic surgery is becoming an increasingly common phenomenon. Over a period of 18 months, 31 children (11 female, 13 male, aged 5–15 years) underwent laparoscopic appendicectomy. Of these, 23 had acute and 8 recurrent abdominal pains. Their operation time ranged from 35 to 98 min and the in-patient stay was 2–8 days. There were no technical failures, however, 3 patients developed complications. Early experience suggests that laparoscopic appendicectomy in children is safe, however, further experience is clearly needed in order to define the advantages of this new technique.     

超声引导内镜下逆行阑尾炎治疗术在阑尾相关慢性腹痛患儿中的应用价值北大核心CSCD

目的 探讨超声引导内镜下逆行阑尾炎治疗术在儿童阑尾相关慢性腹痛中的临床疗效。方法 回顾性收集2019年8月至2021年5月收治的以慢性腹痛为主诉,超声提示阑尾炎症或腔内粪便或粪石且行超声引导内镜下逆行阑尾炎治疗术患儿30例的临床资料,分析其临床表现、内镜下表现、白细胞计数及中性粒细胞百分比、住院时间、治愈率。结果 30例慢性腹痛患儿中,男童13例(43%),女童17例(57%),平均确诊年龄(9±3)岁,年龄范围3~15岁,中位病程持续时间12个月,中位住院时间3 d;中位白细胞计数6.7×10^(9)/L,中性粒细胞百分比为(50±13)%。21例(70%)术中阑尾腔内冲洗出粪石及大量粪渣。随访率97%(29/30),中位随访时间11(范围:5~26)个月,27例(93%)腹痛症状完全消失。结论 超声引导内镜下逆行阑尾炎治疗术对阑尾腔内粪便或粪石引起的儿童慢性腹痛治疗有效。     

Optimizing US examination to detect the normal and abnormal appendix in children

Background US detection of a normal appendix can safely rule out appendicitis. However, there is a wide range of accuracy in detection of a normal appendix. Objective To optimize US examination to detect the normal and the abnormal appendix according to the potential positions of the appendix. Materials and methods This prospective study included 107 children who underwent gray-scale US scanning. Noncompressive and compressive graded sonography was performed to detect normal and abnormal appendices according to their potential positions. The maximum transverse diameter of the appendices was measured. Results Of the 107 children examined, 56 had a histologic diagnosis of acute appendicitis. Sonography had a sensitivity of 100% and specificity of 98% for the diagnosis of appendicitis. A normal appendix was visualized in 44 (86.2%) of the 51 patients without acute appendicitis, and of these 44, 43 were true-negative and 1 was false-positive. Normal and abnormal appendices, respectively, were positioned as follows: 54.4% and 39.3% were mid-pelvic; 27.2% and 28.6% were retrocecal; 11.4% and 17.8% were deep pelvic; and 6.8% and 14.3% were abdominal. Conclusion US scanning according to the potential positions of the appendix was useful in the detection of normal appendices in children suspected of having appendicitis.     

Laparoscopic and conventional appendicectomy in children: outcomes in English hospitals between 1996 and 2006

Background  Laparoscopic appendicectomy is increasingly used in children. This national retrospective study compared outcomes of paediatric open and laparoscopic appendicectomy. Methods  Length of stay, readmission rates and mortality in children undergoing open and laparoscopic appendicectomy in English NHS Trusts between 1 April 1996 and 31 March 2006 were compared. Procedures coded as emergency excision of appendix (OPCS-4 H01) on the Hospital Episode Statistics (HES) database in patients less than 15 years of age were included. Multivariate analysis was used to identify independent predictors of length of hospital stay and mortality. Results  Eighty-nine thousand, four-hundred and ninety-seven (89,497) appendicectomies were studied; of which, 2,689 (3%) were performed laparoscopically. The percentage of laparoscopic cases rose from 0.6 to 8.4% between 1996 and 2006 (Pearson’s r = 0.954, P < 0.001). Length of stay (median 3, interquartile range 2 days, P = 0.068) and 28-day readmission rates were similar (6.3 vs. 7.2%, respectively; P = 0.072) between groups. No independent hospital stay advantage for laparoscopy was observed (P = 0.121). No difference in 30-day mortality (P = 0.986) or 365-day mortality (P = 0.598) was demonstrated. Conclusion  Hospital stay, readmission rates and mortality are similar following laparoscopic and open appendicectomy in children.     

Appendix masses

Over a 15-year period (1970–1985), 3,294 cases of paediatric acute appendicitis were treated in Edinburgh, constituting 9% of total paediatric surgical admissions; 96 (2.9%) presented with an appendix mass. A retrospective review of these cases was performed with reference to the mode of presentation, clinical, radiological, and laboratory findings, and treatment. Fifty-five per cent of the appendices removed at interval appendicectomy were normal. It was also noted that the incidence of acute inflammation increased as the length of time between initial presentation and subsequent interval appendicectomy increased. These points are discussed with a review of the literature. Offprint requests to: D. Wilson-Storey     

Appendicitis in the young child: a continuing diagnostic challenge

OBJECTIVE: The purpose of this review was to examine the presenting signs and symptoms of children 5 years of age or less who underwent operation for appendicitis. In addition, we sought to determine the rate of perforation of the appendix and the effect on outcome in this age group. METHODS: Medical records for the period September 1987 to September 1998 were reviewed for all children 5 years of age or less who underwent appendectomy for appendicitis. Data gathered included age at operation, gender, care sought prior to admission for appendectomy, duration of symptoms, signs and symptoms at the time of admission, and length of postoperative hospital stay. Symptoms of diarrhea, emesis, fever, pain, and anorexia were recorded. Physical signs of an abdominal mass, guarding, rebound tenderness, rigidity, and diffuse or focal tenderness were recorded. Diagnostic information included white blood cell count with differential, and radiographic imaging, if obtained. The presence or absence of perforation of the appendix, and abscess formation were based on the intraoperative impression of the operating surgeon. RESULTS: For the 11-year period, 120 patients 5 years of age or less required an operation for appendicitis and had a complete medical database. The mean age was 3.6 +/- 1.3 years; 53% were male. Patients underwent a separate medical evaluation prior to arriving at a definitive diagnosis in 44.2 % cases. The most common presenting symptom was abdominal pain (94%); the most common sign was abdominal tenderness (95.8%). Tenderness was generally diffuse if perforation had occurred (62%) or focal in the nonperforated group (61%). The duration of symptoms in patients with perforation was more than double that of the nonperforated patients (4.7 vs 2.1 days, respectively). The mean white blood cell count (WBC) was 18.3 +/- 7.4 cells/mm3, and did not differ significantly between the perforated and nonperforated groups. A left shift detected in the WBC differential was present in 91%. An abdominal radiograph was obtained in 87%, and demonstrated a fecalith in 18%. A preoperative ultrasound was obtained in 38%, a computed tomographic scan in 7%. At the time of surgery, 74% were found to have evidence of perforation. An abscess was found at the initial surgery in 47% of patients with appendiceal perforation, but in no patient in whom perforation had not occurred. The rate of perforation increased as the age of the patient decreased (100% perforation for age 1 (n = 10) to 69% for age 5, (n = 35). Perforation was associated with a longer hospital length of stay as compared to the nonperforated appendix (median 9 days vs. 3 days, respectively, P < 0.001). There were no deaths in this series. CONCLUSION: Appendiceal perforation continues to be a common occurrence in the young child and increases in frequency as the age of the patient decreases and the duration of symptoms lengthens. Perforation results in a significant increase in hospital length of stay and rate of abscess formation.     

小儿阑尾炎误诊分析

目的 分析小儿阑尾炎的误诊原因，降低小儿阑尾炎的误诊率，减少术后并发症的发生。方法 回顾我院外科1997～2002年误诊的225例急性阑尾炎的临床资料，通过对其病史、手术所见，实验室及辅助检查结果进行回顾性研究，分析误诊原因。结果术前诊断为其他疾病，手术确诊为阑尾炎的163例；术前诊断为阑尾炎，手术证实为其他疾病的62例。全部病例均经手术治疗，术后痊愈出院，并发症的发生率为16.44％。结论 对小儿急性阑尾炎的临床症状特点缺乏足够的认识，腹部体征的掌握不准确及过多的依赖辅助检查是误诊的主要原因。对酷似阑尾炎的病例，应当允许阑尾误切的存在，但应注意诊断和鉴别诊断，尽量减少误切。     

二孔法儿童微型腹腔镜阑尾切除术

目的 探讨二孔法儿童微型腹腔镜阑尾切除术MLA的可行性及优越性。方法 本组对31例急性阑尾炎患儿行二孔法MLA。术中在脐部和右下腹二孔置入微型腹腔镜器械，将阑尾自5．5mmTrocar孔拖出，体外结扎系膜，切除阑尾，再将阑尾残端回纳腹腔，腹腔镜观察腹腔无异常后，切口对合粘贴。结果 本组31例患儿手术时间25～35min，平均30min，术后8～12h患儿开始饮水，10～12h即可下床活动，术后3～5d均痊愈出院。无切口及腹内并发症。结论 二孔法儿童微型腹腔镜阑尾切除术方法简便，比三孔法腹腔镜阑尾切除术LA更简单、经济，并发症少，手术时间短，切口更小，瘢痕更小，美容效果更好，适用于儿童急性单纯性阑尾炎。     

Acute appendicitis in children under 3 years of age. Diagnostic and therapeutic problems

Aim: Analysis of diagnostic and therapeutic problems in acute appendicitis in children below 3 years of age. Material and methods: The analysis was based on medical data of 53 children under 3 years of age, treated in our department for acute appendicitis in the years 1988-2008. Among 53 children, 29 (53.7%) were admitted directly to the surgical department and 24 (45.3%) were transferred from the regional pediatric department. In the period of 1 month before admission to the surgical department 13 patients (24.5%) were treated as outpatients due to acute respiratory or alimentary tract infection. On the basis of the data from the case histories, the most frequent symptoms and their duration were evaluated, as well as the clinical signs, intraoperative diagnosis and the postoperative course. Results: The most frequent symptoms and clinical signs in this group of children were: abdominal pain, vomiting and fever, present in 83.0%, 75.5%, and 67.0% patients respectively. The mean time of the symptoms' duration was 3.6 days. The most frequently found physical signs on admission to the surgical ward were: abdominal pain on palpation, increased tonus of abdominal muscles and abdominal distension. On laparotomy gangrenous appendicitis was found in 49% of the children operated. In 24.5% of patients perforation of the appendix was confirmed. Further complications occurred in 9 children (16.9%). The average stay in hospital after the operation lasted 7.9 days. Conclusions: 1. Acute appendicitis in small children is a diagnostic problem not only for primary health care doctors but also for experienced pediatricians and pediatric surgeons. 2. Early surgical consultation should be a standard procedure in small children with acute symptoms of various locations when there is accompaning abdominal pain, not reacting to conservative treatment. Surgical consultation is also indicated in children under 3 years of age with relapses of abdominal pain. 3. Clinical signs of appendicitis in children aged less than 3 years, may differ from those in older children due to changes in their immunological reactivity. This problem should be included in under-graduate and post-graduate medical studies.     

Carcinoid tumors of the appendix in children

 We report ten cases of carcinoid tumor of the appendix observed in children from 1988 to 1996. The patients included six females and four males with an average age of 13 years at presentation. They were admitted after complaining of pain in the lower abdominal quadrant. In eight children who presented with symptoms of acute appendicitis, the tumor was located at the tip of the appendix. Diagnosis was performed after appendicectomy (AE) and pathologic examination, which revealed a tumor slightly under 1 cm in size. Two other children were admitted with clinical signs of peritonitis due to larger tumors measuring more than 2 cm on the base of the appendix. One patient underwent a cecectomy, the other a right hemicolectomy. For all patients follow-up was 3 years, and all recovered fully. According to these findings and a review of the literature, we suggest conservative surgical procedures in children. More than 70% of these tumors are localized at the tip of the appendix and represent an incidental pathologic finding during AE; AE alone is curative. Patients with a bulky tumor of the appendicular base measuring 2 cm and invading the serosa and mesoappendix without metastases may be treated with a cecectomy; ileocecal resection may be indicated in cases where the tumor has infiltrated tissue beyond the cecum with localized metastases and in patients with incomplete gross resection. Right hemicolectomy is questionable in this age group and restricted to rare conditions. Accepted: 24 August 2000     

Single preoperative intravenous dose of metronidazole for appendectomy in children

One hundred children were prophylactically treated with 15 mg/kg-1 of metronidazole immediately before appendicectomy and retrospectively compared with 100 other patients without any antibioprophylaxis. No statistically significant difference was found between the two groups as regards age, weight, sex and macroscopic appearance of the appendix. The overall incidence of complications was 1% in the antibioprophylactic group and 9% in the control group. Furthermore, a single pre-operative intravenous dose of metronidazole was as effective as conventional antibioprophylaxis.     

One-trocar transumbilical laparoscopic-assisted appendectomy in children: our experience.

The authors report their experience with one-trocar transumbilical laparoscopic assisted appendectomy (TULAA). From January 1998 to June 2000, 150 patients underwent appendectomy using this technique. Ages ranged from 2.5 to 17.4 years. The procedure was completed using only one trocar in 116 cases (77.3%); in 28 patients (18.7%) one or two additional cannulas were needed. Conversion to open surgery became necessary in 6 cases (4%). Mean operative time was 35 minutes, mean hospital stay 3.5 days. There were no major complications and no mortality in this series. The advantages of a one-trocar appendectomy compared with open surgery are the same as those reported for conventional laparoscopic appendectomy: i.e., excellent exploration of the abdominal cavity, the possibility of discovering extra-appendiceal lesions, easy and rapid localization of the appendix and a shorter hospital stay. The additional advantages of TULAA compared with conventional laparoscopic appendectomy are a low rate of intraoperative incidents, minimal scarring, less postoperative pain and a more rapid return to unrestricted activities.     

Recurrent abdominal pain in young pre-menarchal female: clinical and surgical observations

The purpose of this study is to determine the role of surgical intervention in pre-menarchal patients with recurrent abdominal pain. Seventy-six pre-menarchal females aged 9–12 were examined for recurrent abdominal pain; during clinical observation blood tests were within normal values and abdominal and pelvic US showed no surgical or gynaecological problems. After laparoscopic appendectomy the patients’ clinical–surgical findings were related to their age, relief of symptoms and histopathological findings. A total of 71% of patients showed positive surgical findings; 55.5% of these showed variations in the position of the appendix with mild inflammation and reactive pericaecal lymph nodes, 7.5% had a macroscopic inflammation with adhesions and 37% had a mild inflammation. Twenty-nine percent of patients had a normal appendix without adhesions, inflammations or infections. Histopathological examination showed a pathologic appendix in 60 cases (79%). Six months after surgery abdominal pain persisted in 18 patients out of 76 (23%). There is a statistically significant relationship between recurrent abdominal pain, surgical observation and relief of symptoms (P < 0.05). We believe that patients affected by recurrent abdominal pain need to be closely and simultaneously monitored. For this reason, laparoscopy should be considered and used with those patients suffering from frequent abdominal pain and discomfort.