Examination under anesthesia prior laparoscopic appendicectomy: does it change the approach?

The clinical finding of a mass in the right iliac fossa during the course of diagnosis of acute appendicitis may affect the management approach. A mass is sometimes only evident when the abdomen is examined under anesthesia. This study was conducted to assess the significance of examination under anesthesia and analyze the outcome of laparoscopic exploration and its correlation with the finding of a mass that can be felt only under anesthesia. We conducted a prospective study over 12 months on patients diagnosed with acute appendicitis who were treated with laparoscopic approach. There were 179 patients (101 females) who underwent laparoscopic appendicectomy; 20 cases (11%) were converted to open appendicectomy. Examination under anesthesia revealed a mass in 20 patients (11%). The rate of conversion to open operation was 65% (13 patients) in those who had palpable mass and 4% (7 patients) in those who had no mass (P<0.0001). This study has shown that most patients with a mass found under anesthesia will need conversion of the laparoscopic procedure to an open operation. The recommendation from this study therefore is that all patients planned to have a laparoscopic appendicectomy should have examination under anesthesia; if a mass is found, then the procedure should be converted to open operation from the beginning.