[Open appendectomy. When do we still need it?]

Acute appendicitis is the most common emergency visceral surgical procedure in Germany with 130,000 appendectomies. The question of which operational procedure should be used must therefore be discussed at regular intervals. In many centers of minimal invasive surgery, laparoscopic appendectomy (LA) is the standard procedure. Nearly 30 years after introduction of LA, it is believed that open appendectomy (OA) is needed only on rare occasions, but the actual percentage of OAs carried out in 2006 was 46% of all appendectomies. This high percentage documents that OA is still the standard procedure in many German hospitals. A review of the literature shows that there are still some situations in which OA is superior to LA. Infants younger than 5 years old have a more difficult basic requirement for LA due to the small abdominal cavity, therefore OA is the procedure of choice in most cases. During pregnancy OA has a lower risk for the fetus than LA. Cost analyses show that OA is less expensive for the hospital in material costs, whereas LA is the better economic choice due to an earlier return to work. In summary, there are only marginal differences between the two procedures since both offer a fast patient recovery. Advantages in favor of both LA and OA exist in subgroup analyses and the possible subgroups that can benefit from OA are discussed in this article.