Long-term benefits of laparoscopic appendectomy for chronic abdominal pain in fertile women.

Aim: To assess long-term benefit of laparoscopic appendectomy for chronic abdominal pain of unknown origin in fertile women.
Method: The study included 70 fertile women aged 29.2+/-13.1 years who had undergone diagnostic laparoscopy for recurrent abdominal pain at our Department between 1996 and 2000. In December 2002, a questionnaire with symptom-specific questions and procedure-specific questions was sent to all the patients. The response rate was 76% (53 out of 70).
Results: According to intraoperative findings there were 8 patients with adhesions, 12 with gynecological origin of pain, 27 with chronic inflammation or narrowed lumen of the appendix, and 6 with normal laparoscopic findings and innocent appendix. The most common intervention was appendectomy, performed in 41 out of 53 cases; cysts fenestration in 10 cases; and lysis of adhesions in 8. The average hospital stay was 3.6+/-2.6 days. Postoperative complications occurred in 10/53 patients. A serious complication involving bladder injury after lysis of adhesions occurred in a single patient. There was no mortality. 3 out of 53 patients were readmitted 1, 3, and 9 months postoperatively because of residual abdominal pain. Two of them had appendectomy. Long-term follow up showed that there were no differences in the overall satisfaction with diagnostic laparoscopy in the patients with (n=41) and without appendectomy (n=12). There was no difference in overall satisfaction between the patients having inflamed appendix (n=22) and those without inflamed appendix (n=19).
Conclusion: Diagnostic laparoscopy is a diagnostic and therapeutic option in most fertile women with chronic abdominal right iliac fossa pain of unknown origin. Our results showed low postoperative complications and no mortality rate with laparoscopic appendectomy indicate removal of appendix as a part of diagnostic laparoscopy when the origin of pain is unknown. In some cases of persistent pain, the removal of appendix is beneficial by eliminating appendicitis in differential diagnosis.