Laparoscopic surgery is particularly useful in women

Early appendicectomy was first recommended and performed for non-perforated acute appendicitis in the 1880s. The operation remains the most common in the Western world, accounting for a million hospital days per year in the United States.1 Despite more than 100 years' experience, accurate diagnosis still evades the surgeon, and avoiding perforation and subsequent complications must be weighed against removal of a normal appendix in patients with other causes of abdominal pain—a “negative” appendicectomy—which has a rate as high as 20%.2 This is not a trivial problem. Flum and Koepsell assessed its impact in the United States—length of stay, rate of complications, and mortality (1.5% v 0.2%) were all significantly higher in the negative appendicectomy group, and the annual cost of a negative appendicectomy was calculated at $742m.3

The use of an objective scoring system such as the Alvarado system can reduce the negative appendicectomy rate to 0-5%.4The simple expedient of close observation and repeated re-evaluation has in itself been shown in several studies to reduce …