[Minilaparoscopic appendectomy: which indications?]

Laparoscopy has gained widespread acceptance in common surgical practice as a diagnostic and therapeutic tool. Suspected appendicitis is still a diagnostic challenge to the general surgeon. A correct diagnosis is crucial because of the various diseases that may be responsible for the same symptoms, in order to plan the appropriate procedure or avoid an unnecessary laparotomy. Laparoscopy is the only minimally invasive technique to allow at the same time for adequate diagnosis, appropriate treatment and the best abdominal approach. Minilaparoscopy would appear to be a natural further step in the development of this technique. The aim of the present work was to illustrate retrospectively the results of an initial case-control study of minilaparoscopy vs. laparoscopy carried out at our institution. Between January and December 2002 a total of 86 patients underwent emergency and/or urgent appendectomy. Among them, 68 (79%) were operated on laparoscopically (37 [54.4%] with a minilaparoscopic approach and 31 with conventional laparoscopy), while 18 (21%) were treated by laparotomy, as performed by a well-trained surgical team. In the minilaparoscop group we registered no conversions to laparotomy and only one major postoperative complication (intra-abdominal abscess treated laparoscopically). As regards the postoperative period, generally speaking, the patients' conditions (analgesic treatment, flatus, diet, hospital discharge) were broadly the same as in the laparoscopic group. Though limited by its initial retrospective character, the present study shows that minilaparoscopic appendectomy is as safe and effective as classical laparoscopic surgery, and seems to be associated with less trauma and a more rapid postoperative recovery. Such features make minilaparoscopy a challenging alternative to conventional laparoscopy (and, of course, laparotomy) in patients referred for urgent abdominal and/or pelvic surgery.