title: High rates of appendicectomy in a developing country: an attempt to contribute to a more rational use of surgical resources.
abstract: OBJECTIVE
  In view of the high appendicectomy rate in a university teaching hospital in a developing country, we investigated the regional epidemiology of appendicitis.
  
  
  METHODS
  Prospective clinical and pathological study.
  
  
  METHODS
  Teaching hospital, Madagascar.
  
  
  METHODS
  165 patients who underwent appendicectomy during a two month period.
  
  
  METHODS
  Clinical investigation and histopathological examination of removed appendixes.
  
  
  METHODS
  Appendicitis score, local incidence of appendicectomy, appendicitis, perforation, and negative appendicectomy.
  
  
  RESULTS
  There was a high incidence of primary appendicectomy (51.1/10,000 population/year) in relation to the incidence of histologically confirmed appendicitis (7.7/10,000), resulting in a negative appendicectomy rate of 85% (43/10,000). There were considerable sex related differences in the incidence of primary appendicectomy (81/10,000 women/year; 22/10,000 men), appendicectomy for appendicitis (12/10,000 women/year; 4/10,000 men) and non-perforating appendicitis (8/10,000 women/year; 2/10,000 men), but much less in that of perforating appendicitis (4/10,000 women/year; 2/10,000 men).
  
  
  CONCLUSIONS
  There is potential for more economic use of medical resources by reducing the rate of negative appendicectomy. The incidence of non-perforating appendicitis depends on the number of appendicectomies done, which may explain the differences observed in the incidence of appendicitis between industrialised and developing countries.
authors.affiliation: Department of General Surgery, University of Sarre, Homburg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Langenscheidt
authors.forename: C
authors.initials: C
authors.lastname: Lang
authors.forename: W
authors.initials: W
authors.lastname: Püschel
authors.forename: G
authors.initials: G
authors.lastname: Feifel
mesh_terms: D001062:Appendectomy / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D003906:Developing Countries / Q000706:statistics & numerical data; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D017678:Sex Distribution; D011795:Surveys and Questionnaires