World Journal of Laparoscopic Surgery

Register      Login

VOLUME 2 , ISSUE 2 ( May-August, 2009 ) > List of Articles


Management of the Normal Appendix during Laparoscopy for Right Iliac Fossa Pain

E Jane H Turner, Robin Lightwood

Citation Information : Turner EJ, Lightwood R. Management of the Normal Appendix during Laparoscopy for Right Iliac Fossa Pain. World J Lap Surg 2009; 2 (2):15-17.

DOI: 10.5005/jp-journals-10007-1018

Published Online: 01-08-2011

Copyright Statement:  Copyright © 2009; The Author(s).


The advent of laparoscopic surgery raises the question of what to do with a normal appendix at laparoscopy for right iliac fossa pain of uncertain origin. We assess the views of all members of the Association of Laparoscopic Surgeons of Great Britain and Ireland (ALSGBI) via means of a survey. Of 135 responses to the questionnaire 61% of surgeons remove a macroscopically normal appendix and 26% do not. 13% of surgeons do not commit. Of those removing a normal appendix the most common reasons given were the possibility of endoluminal appendicitis (87%) and avoiding future confusion as to whether the appendix had been removed (64%). When asked whether there were sufficient guidelines on this topic 68% said no, 6% said yes and 5% were unsure. 16% said that it was a matter for common sense rather than guidelines and 5% felt that the evidence was contradictory. This study highlights a lack of consensus in the management of a normal appendix found at laparoscopy for right iliac fossa pain and demonstrates most surgeons feel guidelines would be useful. In the absence of guidelines the options may be discussed with the patient before operation.

PDF Share
  1. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidimiol 1990;132:910-25.
  2. The incidence of acute appendicitis and appendectomy: an epidemiological study of 971 cases. Acta Chirugica Scandinavica 1982;148:45-49.
  3. Diagnostic accuaracy and perforation rate in appendicitis: association with age and sex of the patient and with appendectomy rate. Eur J Surg 1992;158:37-41.
  4. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986;15:557-64.
  5. Should the normal appendix be removed at operation for appendicitis. J R Coll Surg Edinb 1993;38:158-60.
  6. Is a histologically normal appendix following emergency appendectomy always normal? Lancet 1996;347:1076-79.
  7. Should every patient undergoing laparoscopy for clinical diagnosis of appendicitis have an appendicectomy? Acta Chir Belg Feb 2003;103(1):87-89.
  8. ‘What you see is not what you get’. A plea to remove a ‘normal’ appendix during diagnostic laparoscopy. Acta Chir Belg 2001;101(5):243-45.
  9. Previous laparoscopy in abdominal pain-confusion or clarification. Ir J Med Sci 2001;170:28(Abstract).
  10. Letter in BJS 2002;89:663-70.
  11. 257 incidental appendicectomies during total laparoscopic hysterectomy. JSLS 2007;11(4):428-31.
  12. Incidental appendectomy during radical cystectomy-Is it necessary? Urology 2002;59:678-80.
  13. Recurrent appendicitis following laparoscopic appendectomy. Report of a case. Dis Colon Rectum 1994;37:719-20.
  14. Acute appendicitis: does removal of a normal appendix, matter, what is the value of diagnostic accuracy and is surgical delay important? Ann R Coll Surg Engl 1995;77:358-63.
  15. Intestinal obstruction after appendectomy. Scand J Gastroenterol 1997;32:1125-28.
  16. Consequenses of removal of a ‘normal’ appendix. Med J Aust 1993;1:370-72.
  17. Implications of removing a normal appendix. Digestive Surgery 2003;20(3):215-19.
  18. Selective use of diagnostic laparoscopy in patients with suspected appendicitis. Surg Endos 2000;14(10):938-41.
  19. The utility of laparoscopy in the diagnosis of acute appendicitis in women of reproductive age. Surg Endosc 2003;17(8):1311-13.
  20. Should an appendix that looks ‘normal’ be removed at diagnostic laparoscopy for acute right iliac fossa pain. Eur J Surg 2000;166(5):388-89.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.