Chronic or Recurrent Appendicitis Clinical Trial
Official title:
Elective Laparoscopic Appendectomy for Chronic Right Lower Abdominal Pain; Outcome of a Prospective Randomized Double-Blind Controlled Surgical Trial
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.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Double-Blind, Primary Purpose: Treatment