The greatest change in general surgery techniques in the last period of time was the use of laparoscopy for different types of interventions. Laparoscopic method was quickly applied also in surgery of acute appendicitis. Although it provides most useful and rapid information through mini invasive incisions, Laparoscopy hasn't been adopted as an exclusive surgical method.



In a study made on about 3500 cases of appendicitis, scientists tried to show the benefits and also the negative aspects of Laparoscopy in comparison to appendicectomy by open incision. The establishment was a decrease of wound infections, rate of pain at postoperatory level, number of days in hospital needed and faster return to normal activities in case of laparoscopy. But the risk of intraabdominal abscesses increased. The conclusion was avoiding laparoscopic appendicectomy unless performed by a very experienced surgeon, if a perforation of the appendix is suspected.

The most useful use of laparoscopic method was in young women with uncertain diagnosis to avoid an unnecessary and also wrong surgical intervention. Young women are likely to have similar pains in appendicitis and genital pathology, so a laparoscopic investigation can help diagnosing a tubo-ovarian pathology that can later be cured by endoscopical ways.

A clinical study was made using several groups of young female patients suspected of appendicitis through the Alvarado score. The groups were differently investigated and diagnosed. The ones explored by laparoscopy showed about 10% false appendicitis diagnosis and escaped operation. In the group examined by other medical methods a share of 18% were wrong diagnosed and normal appendicectomy was performed.

In spite of the new laparoscopic techniques the clinical abilities of the surgeon should still be most important in diagnosing any pathology, including cases of acute appendicitis. An experienced surgeon with well trained clinical judgment can evaluate more rapid and efficient an uncertain case. The inflammation of the appendix is an emergency always, but despite this, organ perforation cannot occur in such short period of time.

Systems used for scoring like Alvarado score can be helpful to ensure the attention to all apparent non-significant detail.

Although ultrasonography cannot work as a scoring instrument, it can sometimes provide vital evidence and data, when the diagnosis is uncertain. For old or physically unfit patients with suspicion of a different assembling pathology, computerized tomography is recommended for differential diagnosis.

Even if laparoscopy is the best manner to avoid appendicectomy in case of genital problems in young women, it should also be avoided if suspicions about perforation of the appendix exist.

For this reasons we are challenged to have most qualified surgeons in mini-invasive, laparoscopic interventions. Surgeons must be prepared to deal with uncertain diagnosis inside the operation room in spite of the initial, pre-operator diagnosis.