Our experience with selective laparoscopy through an open appendectomy incision in the management of suspected appendicitis

BACKGROUND: An accurate preoperative diagnosis of suspected appendicitis at times can be extremely difficult. We report our experience with a simple strategy of selective laparoscopy through an open appendectomy incision after finding a noninflamed appendix in the management of suspected appendicitis. METHODS: Patients presenting with suspected appendicitis after regular office hours (6 pm to 8 am weekdays and weekends) were recruited prospectively from January 2002 to December 2003. Laparoscopy through an open appendectomy incision was performed only when the appendix was found to be normal. RESULTS: Twenty-five (18.5%) of 135 patients underwent laparoscopy through an open appendectomy incision because of a normal-looking appendix. Laparoscopy through an open appendectomy incision helped to identify additional intra-abdominal pathology in 13 (52%) of the 25 patients; thus improving the overall detection rate of underlying pathology from 81.5% (110 of 135) to 91.2% (123 of 135). CONCLUSIONS: Selective laparoscopy through an open appendectomy incision in patients with a noninflamed appendix is a simple technique that can identify potentially fatal pathology and also maintains a valuable training opportunity for young surgeons to perform open abdominal surgery. We recommend using this technique in the management of suspected appendicitis.