Should an appendix that looks 'normal' be removed at diagnostic laparoscopy for acute right iliac fossa pain?

Objective: To find out whether the removal of the appendix from patients in whom laparoscopy for acute right iliac fossa pain shows no abnormality is justified to avoid the risk of missing acute appendicitis.

Patients: The records of patients who, between 1990 and 1997 had emergency laparoscopy for acute right iliac fossa pain were reviewed. Only those in whom laparoscopy had shown no abnormality and had not had the appendix removed were included in the study.

Methods: Outcome was assessed by telephone questionnaire to the patient, the general practitioner, or both.

Results: Emergency laparoscopy had been done for 254 patients. No abnormality was detected in 41. Full follow up was available on 34 patients (83%). 21 patients have remained entirely free of symptoms. Of the 13 patients who had recurrent symptoms, 2 subsequently had a histologically normal appendix removed, yet still had symptoms; 2 had a second laparoscopy that showed no abnormality; 5 had ultrasound; and 4 had colonoscopy or a barium enema examination.

Conclusion: Removal of an appendix that looks 'normal' at emergency laparoscopy for right iliac fossa pain is unjustified.