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INTRODUCTION The increased use of diagnostic laparoscopy for management of right iliac fossa pain may have lowered the threshold for removing normal appendices, particularly as there is a perception that this practice carries little additional morbidity. The aim of this retrospective audit was to determine the negative appendicectomy rate after laparoscopic appendicectomy (LA) in our busy district hospital, and to compare the relative incidence and severity of complications after removal of an inflamed or non-inflamed appendix. METHODS Adult patients who underwent LA in 2011-2012 were identified from theatre registers. Histology results were reviewed to differentiate between inflamed and normal appendices. Postoperative complications and events following discharge were identified via electronic patient records. Complication severity was stratified using the Clavien-Dindo classification. RESULTS Over 2 years, 467 LAs were performed, of which 143 (30.6%) were for normal appendices. Significantly more negative appendicectomies were performed in women (43%) than in men (17%) (p<0.0001). Complications were seen in 62 patients (13.3%). There was no significant difference between the complication rates for those who had an inflamed (16.6%) or non-inflamed (11.9%) appendix (p=0.141). Similarly, there was no difference in the severity of complications between these groups. Reoperation or invasive intervention was required after four negative appendicectomies (2.8%). CONCLUSIONS LA carries a similar morbidity regardless of whether the appendix is inflamed. Negative appendicectomy should not be undertaken routinely during laparoscopy for right iliac fossa pain.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; OR: Odds ratio; GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

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