Chronic or Recurrent Appendicitis
Conditions
Keywords
Abdominal pain, Appendectomy, Laparoscopy, Chronic appendicitis, Appendicopathy
Brief summary
It is questionable whether elective appendectomy can effectively reduce pain in persistent or recurrent lower abdominal quadrant pain due to chronic appendicitis. A single centre randomised double-blind sham surgery controlled clinical trial studied the effects of elective laparoscopic appendectomy on postoperative pain perception in patients with persistent or recurrent lower abdominal quadrant pain on abdominal pain at 6 months postoperatively. Secondary outcome was the relation between clinical response and the appendix' histopathology. The analysis was performed on an intention-to-treat basis. Pain scores were compared using a Fisher's exact test.
Detailed description
Forty patients were randomised, 18 patients had a laparoscopic appendectomy and 22 patients had a laparoscopic inspection only. The postoperative pain scores were significantly different favouring appendix removal (p \< 0.01). Relative risk calculations indicated a 2.4 fold (95% CI: 1.3 - 4.0) greater chance of improving or becoming pain free after laparoscopic appendectomy. The number needed to treat was 2.2 patients (95% CI: 1.5 - 6.5). There was no significant relation between postoperative pain scores and histopathology findings. Conclusions Chronic or recurrent appendicitis is a realistic clinical entity that can be treated successfully by elective appendectomy leading to significant pain reduction in properly selected cases. Histopathology of the removed appendix does not contribute to the diagnosis.
Interventions
PROCEDURElaparoscopic appendectomy or not (surgery)
Sponsors
Maxima Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
DOUBLE
Eligibility
Sex/Gender
ALL
Age
15 Years to 45 Years
Healthy volunteers
No
Inclusion criteria
* Patients were eligible if they were between 15 and 45 years of age, and if they suffered from chronic or recurrent right lower abdominal quadrant pain for more than three months. They were to experience continuous pain, or should have endured at least one pain attack in the month prior to inclusion.
Exclusion criteria
*
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Primary outcome: pain reduction | — |
| The primary outcome measure was pain scored by the blinded patient at 6 months postoperatively | — |
Secondary
| Measure | Time frame |
|---|---|
| Secondary outcome: histopathology | — |
| The secondary outcome parameter was the relation between clinical improvement and histopathological findings of the removed appendices | — |
Outcome results
None listed