caa a22 4500 475779495 CHVBK 20180406123640.0 cr unu---uuuuu 170329e20000701xx s 000 0 eng 10.1007/s004640000122 doi (NATIONALLICENCE)springer-10.1007/s004640000122 Macroscopic assessment of the appendix at diagnostic laparoscopy is reliable [Elektronische Daten] [M. Kraemer, C. Ohmann, R. Leppert, Q. Yang] Background: Healthy-looking appendixes are often removed at laparoscopy for suspected appendicitis. This practice may have adverse secondary effects. Methods: We reviewed the literature for the years 1978 to 1998 to analyze the negative appendectomy rates, complication rates, the accuracy of laparoscopic appendix assessment, and the incidence of false negative diagnosis of appendicitis at surgical and gynecological laparoscopy. Results: The respective negative appendectomy rates were 22% and 15% in studies that compared laparoscopic with open appendectomy. The appendix was left in situ in 37% of 4,281 surgical diagnostic laparoscopies. There were instances of missed appendicitis among the 3,367 gynecological diagnostic laparoscopies performed on women for lower abdominal pain, and there were 188 appendectomies in this group. Studies comparing the macroscopic appearance of the appendix at operation with microscopic findings from the excised specimen had a false negative error rate of 3%. Conclusions: Contrary to general opinion, there is no substantial evidence to support the assumption that the macroscopic diagnosis of appendicitis is unreliable. High rates of conflicting diagnoses of excision specimens suggest that endoappendicitis has little clinical significance. At present, negative appendectomy rates are considerably higher for laparoscopic appendectomy than for the open approach. The role of diagnostic laparoscopy in suspected appendicitis should be reconsidered. It may be useful in particular subgroups of patients, but it is no substitute for good clinical judgment. Furthermore, it is not always necessary to perform an incidental appendectomy. Springer-Verlag New York Inc., 2000 Key words: Abdominal pain — Appendicitis — negative appendicectomy rate — Histology nationallicence Kraemer M. Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore aut Ohmann C. Theoretical Surgery Unit, Department of General and Trauma Surgery, Heinrich Heine Universität, Moorenstr. 5, Düsseldorf, Germany, Germany aut Leppert R. Surgical Clinic and Policlinic, Julius Maximilians University, Josef-Schneider-Str. 2, 97080, Würzburg, Germany, Germany aut Yang Q. Theoretical Surgery Unit, Department of General and Trauma Surgery, Heinrich Heine Universität, Moorenstr. 5, Düsseldorf, Germany, Germany aut Surgical Endoscopy Springer-Verlag 14/7(2000-07-01), 625-633 0930-2794 14:7<625 2000 14 464 https://doi.org/10.1007/s004640000122 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004640000122 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kraemer M. Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore aut NATIONALLICENCE 700 1- Ohmann C. Theoretical Surgery Unit, Department of General and Trauma Surgery, Heinrich Heine Universität, Moorenstr. 5, Düsseldorf, Germany, Germany aut NATIONALLICENCE 700 1- Leppert R. Surgical Clinic and Policlinic, Julius Maximilians University, Josef-Schneider-Str. 2, 97080, Würzburg, Germany, Germany aut NATIONALLICENCE 700 1- Yang Q. Theoretical Surgery Unit, Department of General and Trauma Surgery, Heinrich Heine Universität, Moorenstr. 5, Düsseldorf, Germany, Germany aut NATIONALLICENCE 773 0- Surgical Endoscopy Springer-Verlag 14/7(2000-07-01), 625-633 0930-2794 14:7<625 2000 14 464 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer