Laparoscopic Appendectomy for Chronic Right Lower Abdominal Pain
Laparoscopic Appendectomy for Chronic Right Lower Abdominal Pain
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.
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.
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:

 -  Exclusion criteria consisted of (a history of) chronic back pain, previous abdominal
 surgery (with the exception of diagnostic laparoscopies or a laparoscopic
 sterilization), specific gastro-intestinal entities (such as inflammatory bowel
 disease) and gynaecological disease (all female patients consulted a gynaecologist).
 Routine laboratory investigations included hemoglobin rate, serum leukocyte count and
 differentiation, C-Reactive Protein concentration, Erythrocyte Sedimentation Rate,
 faeces cultures and urine sedimentation. Barium contrast studies of the colon were
 done in all patients, abdominal ultrasound or enteroclysis on discretion. Finally,
 exclusion was possible when diagnostic laparoscopy revealed abnormalities (see below).