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[Laparoscopic appendectomy. The new standard?]
F Köckerling1, C Schug-Pass, S Grund
1Klinik für Chirurgie - Visceral- und Gefässchirurgie, Vivantes Klinikum Spandau, Neue Bergstrasse 6, Berlin, Germany. ferdinand.koeckerling@vivantes.de
Abstract:
Since the introduction of laparoscopic appendectomy by Semm in 1983, the role of this minimally invasive surgical technique has been the focus of controversial discussion. Meta-analyses have identified its advantages as having significantly lower wound infection rates, less postoperative pain and earlier resumption of normal everyday activities. The disadvantages are higher rates of intra-abdominal abscesses, longer operating times and higher inpatient treatment costs. However, some of the advantages identified by meta-analyses have been called into question by the results obtained from research into aspects of care. These discrepancies are attributable to the different surgeons involved in the various studies. The results are greatly influenced by the qualifications and experience of the surgeons. Therefore conventional appendectomy using a right lower lateral McBurney incision should continue to be the gold standard. Surgeons who have extensive experience in the field of laparoscopic surgery can achieve better results with minimally invasive appendectomy than with open surgery. This also holds true for specific situations such as complicated appendicitis and for morbidly obese patients. However, the operating costs incurred for laparoscopic appendectomy are higher because it has been shown that removal of the appendix with a linear stapler is the most reliable method.
Insights
Laparoscopic appendectomy offers benefits like fewer infections but has drawbacks. Surgeon experience significantly impacts outcomes, making open surgery the standard, though laparoscopy excels in complex cases.
Area of Science:
- Surgical Innovation
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Laparoscopic appendectomy, introduced in 1983, remains a subject of debate.
- Meta-analyses suggest advantages such as reduced wound infections and pain, but also note higher abscess rates and costs.
Purpose of the Study:
- To critically evaluate the efficacy and outcomes of laparoscopic appendectomy compared to conventional open surgery.
- To identify factors influencing the discrepancies in reported outcomes for laparoscopic appendectomy.
Main Methods:
- Review of meta-analyses and studies comparing laparoscopic and open appendectomy.
- Analysis of factors influencing surgical outcomes, including surgeon experience and patient characteristics.
Main Results:
- While laparoscopy shows benefits, outcomes are highly dependent on surgeon expertise.
- Open appendectomy (McBurney incision) is considered the gold standard due to consistent results.
- Laparoscopic appendectomy can yield superior results in specific scenarios, including complicated appendicitis and obese patients, but incurs higher costs.
Conclusions:
- Surgeon experience is a critical determinant of laparoscopic appendectomy success.
- Conventional open appendectomy remains the benchmark, but experienced laparoscopic surgeons can achieve better outcomes.
- Laparoscopic appendectomy is advantageous for select patient groups and complex cases, despite higher associated costs.
