Acute appendicitis or gynecological disease? The role of videolaparoscopic approach

Background: The laparoscopic approach for suspected appendicitis is increasingly gaining acceptance even if its remain controversial. Many Authors suggest the usefulness of laparoscopic approach in women of reproductive age because of the high rate of wrong diagnosis for gynecological diseases.Material and Methods: during a period of 2 years at our Institution 130 patients underwent to appendectomy for suspected acute appendicitis. Of those 40 were female in reproductive age and underwent to laparoscopic procedure. In 36 cases a preoperative gynecological examination was carried out and was negative. Results: in all cases the procedure was completed laparoscopically and the postoperative complication rate was 0%. The definitive diagnosis was: acute appendicitis in 15cases (37,5%), complicated appendicitis with abscess or peritonitis in 15 cases (37,5%) and gynecological unknown disease in 10 cases (25%) associated with chronic appendicitis. In the last group of patients both appendicitis and gynecological disease were treated in the same procedure.Conclusions: laparoscopic appendectomy is to be considered as safe as open and if in the male patients it hasn’t got obvious advantages, in women of reproductive age is able to perform a correct differential diagnosis with pelvic diseases and it permit to treat different disorders during a sole procedure and with the same mini-invasive accesses. The high rate of false negative in the diagnosis of pelvic diseases in the preoperative diagnostic tests justified the systematic use of laparoscopic approach in female patients with suspected acute appendicitis.