La videolaparoscopia nel paziente con dolore in regione iliaca destra

The authors report on their experience of 235 laparotomy operations and 125 laparoscopic operations performed on patients with right lower abdominal pain. Concerning each of these different approaches, the authors analyzed and compared preoperative diagnosis, anatomo-pathological findings, intraoperative and early post operative morbidity and hospital stay. The ratio of negative open-appendectomies was 24.1% (56 cases out of 233). The laparoscopic approach, performed on 88 cases of suspected appendicitis, allowed to document and to treat other pathologies, real causes of the lower right abdominal pain, in 42 cases (47.7%). The rate of conversion from laparoscopic appendectomy to open appendectomy was only 2.19% (2 cases out of 91). The morbidity rate of laparoscopic appendectomy was estimated at 6.5% (4.4% major complications, 2.2% minor complications). The morbidity rate of open appendectomy was estimated at 8.9% (0.4% major complications, 8.5% minor complications). Though the median postoperative stay, after laparotomy approach, was slightly longer (2.6 days versus 2.4 days), the difference was not statistically significant. Based on these results, the authors conclude that the laparoscopic approach should be reserved for fertile female patients, especially when the diagnosis of appendicitis is uncertain.