Laparoscopic appendectomy: differences between male and female patients with suspected acute appendicitis.
BACKGROUND
The role of laparoscopy in the management of patients with suspected acute appendicitis remains controversial. It has been suggested that laparoscopy is useful mainly in young women of reproductive age because of the high incidence of wrong diagnosis in these patients.


METHODS
Different management protocols for patients with suspected acute appendicitis were prospectively used in male and female patients; women of reproductive age were treated laparoscopically, while men were randomised to open or laparoscopic appendectomy.


RESULTS
From September 2002 to September 2005, 132 patients-54 women and 78 men-with suspected acute appendicitis were treated according to the protocol. The incidence of wrong diagnosis in female patients was high (26% and the conversion rate low (5.5%). In contrast, in the laparoscopic male subgroup, these rates showed a reverse relationship (5.2% and 18.5%, respectively). Morbidity did not differ between female and male patients or between the 2 arms of the male group. Laparoscopic appendectomy took longer to perform without affecting significantly the needs for postoperative analgesia, the duration of hospital stay and the time to return to normal activities when compared with open appendectomy in men.


CONCLUSIONS
Laparoscopic appendectomy is at least as safe as the open procedure in the male population, although it does not appear to offer any obvious advantage over the open procedure. The diagnostic advantage that laparoscopy offers to fertile women makes the procedure attractive for this population.
Tzovaras
George
G
The Department of Surgery, School of Medicine, University of Thessaly, University Hospital of Larissa, Larissa, Greece. gtzovaras@hotmail.com
Liakou
Paraskevi
P
Baloyiannis
Ioannis
I
Spyridakis
Michael
M
Mantzos
Fotios
F
Tepetes
Konstantinos
K
Athanassiou
Evaghelos
E
Hatzitheofilou
Constantine
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods*; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery*; D002985:Clinical Protocols; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012737:Sex Factors; D016896:Treatment Outcome