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To the Editor: Dr Flum and colleagues¹ reported that the rate of misdiagnosis of appendicitis has remained unchanged during the last decade, although the use of ultrasound, computed tomography, and laparoscopy has increased. They found a significant increase of unnecessary laparoscopic appendectomies (LAs), especially in the high-risk group of women aged 15 to 45 years. This result cannot be used as an argument against laparoscopic appendectomy, because the potential for selection bias in observational studies is high.

Four randomized controlled trials^2-5 have investigated the effects of diagnostic laparoscopy on negative appendectomy rate. They all found a reduction of misdiagnoses with laparoscopy, especially in women of childbearing age, with relative risks of 0.09 to 0.28. All 4 trials were performed on unselected women who normally would have undergone conventional appendectomy. The appendix was left in situ if any other intra-abdominal pathology was found, but was removed regardless of gross appearance when . . . [Full Text of this Article]

RELATED ARTICLE

Has Misdiagnosis of Appendicitis Decreased Over Time?: A Population-Based Analysis
David R. Flum, Arden Morris, Thomas Koepsell, and E. Patchen Dellinger
JAMA. 2001;286(14):1748-1753.
ABSTRACT | FULL TEXT