caa a22 4500 475780280 CHVBK 20180406123642.0 cr unu---uuuuu 170329e20001001xx s 000 0 eng 10.1007/s004640000226 doi (NATIONALLICENCE)springer-10.1007/s004640000226 Selective use of diagnostic laparoscopy in patients with suspected appendicitis [Elektronische Daten] [W. van den Broek, A. Bijnen, P. van Eerten, P. de Ruiter, D. Gouma] Background: Diagnostic laparoscopy has been introduced as a new diagnostic tool for patients with acute appendicitis. We performed diagnostic laparoscopy when the clinical diagnosis of appendicitis was in doubt. The aims of this study were to evaluate this strategy and to analyze the efficacy of diagnostic laparoscopy in patients with suspected appendicitis. Patients and Methods: All patients referred to our hospital with suspected appendicitis during the period 1994-1997 were evaluated prospectively. The clinical diagnosis was determined by the surgeon or resident on call based on the patient's history, physical examination, and leukocyte count. The patients were divided into three groups: group 1: appendicitis not likely. These patients were observed for 24 h or discharged. When they showed signs of appendicitis in 24 h, they were transferred to either group 2 or 3; group 2: doubt concerning diagnosis. These patients underwent diagnostic laparoscopy, and appendectomy was performed if indicated; group 3: In these patients the diagnosis appendicitis was felt to be certain. They were treated by primary appendectomy by an open procedure. In this study, 1,050 patients, 531 women (51%), 389 men (37%), and 130 children (12%) <11 yrs, were evaluated. Results: Altogether, 377 diagnostic laparoscopies were performed, leaving 109 healthy-looking appendices in place. This reduced the negative appendectomy rate from 25% to 14% in all surgically managed patients. The negative appendectomy rate for the women in group 2 was reduced from 49% to 14%, and for the men from 22% to 11%, so it also seemed worthwhile to perform diagnostic laparoscopy in men. Because the appendix sana was left in place in only three children, the benefit from laparoscopy is relatively small for children. In 48% of these patients a second diagnosis was obtained, most of them gynecologic in nature. There were no false-negative laparoscopies and no complications resulting from the laparoscopic procedure. Conclusions: Diagnostic laparoscopy is a safe procedure that reduced the appendix sana rate without increasing the total number of operations. It is a useful method for obtaining other, mostly gynecologic, diagnoses. To further reduce the appendix sana rate, better criteria for laparoscopic assessment of the appendix are needed. Springer-Verlag, 2000 Appendectomy nationallicence Appendicitis nationallicence Diagnosis nationallicence Laparoscopy nationallicence van den Broek W. Department of Surgery, Medisch Centrum Alkmaar, Secretariaat Chirurgie, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands aut Bijnen A. Department of Surgery, Medisch Centrum Alkmaar, Secretariaat Chirurgie, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands aut van Eerten P. Department of Surgery, Medisch Centrum Alkmaar, Secretariaat Chirurgie, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands aut de Ruiter P. Department of Surgery, Medisch Centrum Alkmaar, Secretariaat Chirurgie, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands aut Gouma D. Department of Surgery, Academisch Medisch Centrum, Amsterdam, The Netherlands aut Surgical Endoscopy Springer-Verlag 14/10(2000-10-01), 938-941 0930-2794 14:10<938 2000 14 464 https://doi.org/10.1007/s004640000226 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004640000226 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- van den Broek W. Department of Surgery, Medisch Centrum Alkmaar, Secretariaat Chirurgie, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands aut NATIONALLICENCE 700 1- Bijnen A. Department of Surgery, Medisch Centrum Alkmaar, Secretariaat Chirurgie, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands aut NATIONALLICENCE 700 1- van Eerten P. Department of Surgery, Medisch Centrum Alkmaar, Secretariaat Chirurgie, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands aut NATIONALLICENCE 700 1- de Ruiter P. Department of Surgery, Medisch Centrum Alkmaar, Secretariaat Chirurgie, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands aut NATIONALLICENCE 700 1- Gouma D. Department of Surgery, Academisch Medisch Centrum, Amsterdam, The Netherlands aut NATIONALLICENCE 773 0- Surgical Endoscopy Springer-Verlag 14/10(2000-10-01), 938-941 0930-2794 14:10<938 2000 14 464 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer