title: An international survey of opinion regarding investigation of possible appendicitis and laparoscopic management of a macroscopically normal appendix.
abstract: BACKGROUND
  The use of imaging and laparoscopy in patients with right iliac fossa pain as tools to make or exclude a diagnosis of appendicitis is at the discretion of the clinician. We sought to establish a consensus of opinion on this matter by surveying professional bodies for laparoscopic  surgery in France, Italy and the US.
  
  
  METHODS
  A survey was sent to members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the French Society for Endoscopic Surgery (SFCE) and the Italian Society for Endoscopic Surgery (SICE). The survey asked about management  of both male and female patients presenting with right iliac fossa pain and what operative strategy the respondents would pursue should they find a macroscopically normal appendix at laparoscopy.
  
  
  RESULTS
  A total of 364 responses were returned from the three groups. The responses from  SAGES showed computed tomography to be the preferred modality for investigating patients with right iliac fossa pain, irrespective of sex. Both SFCE and SICE preferred the use of diagnostic laparoscopy, especially in the female patient group. The majority of all respondents stated that they  would remove a macroscopically normal appendix at laparoscopy.
  
  
  CONCLUSIONS
  Laparoscopy remains a potent tool in the management of appendicitis. However, the dilemma of when to remove a macroscopically normal appendix remains. Our study shows that removal of the appendix in this instance  would be supported by an international consensus.
authors.affiliation: Warwickshire Surgical Research Group, University Hospitals Coventry & Warwickshire NHS Trust, UK. ssj@doctors.org.uk
authors.forename: S S
authors.initials: SS
authors.lastname: Jaunoo
authors.forename: A L
authors.initials: AL
authors.lastname: Hale
authors.forename: J P M
authors.initials: JP
authors.lastname: Masters
authors.forename: S R
authors.initials: SR
authors.lastname: Jaunoo
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000601:surgery; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery*; D001065:Appendix / Q000473:pathology / Q000601:surgery*; D004739:England; D005260:Female; D005602:France; D019538:Health Care Surveys; D006801:Humans; D010535:Laparoscopy; D008297:Male; D014481:United States