Minimally Invasive Surgical Techniques in the Treatment of Appendicitis: A Narrative Review

Acute appendicitis is the most common abdominal surgical emergency worldwide, conventionally managed through open appendectomy until the advent of minimally invasive techniques. This narrative review gathers current evidence on minimally invasive surgical approaches for appendicitis, such as laparoscopic, single-incision, robotic, natural orifice transluminal endoscopic surgery, and endoscopic retrograde appendicitis therapy. The primary objective was to assess the efficacy, accessibility, and challenges of these techniques while addressing barriers to global implementation and strategies for optimization. Laparoscopic appendectomy is considered the gold standard, offering shorter hospital stays, reduced postoperative pain, and fewer surgical site infections compared to open surgery. Innovations such as single-incision laparoscopy and endoscopic retrograde appendicitis therapy show promise in enhancing cosmetic outcomes and organ preservation but encounter limitations because of technical complexity, costs, and infrastructural requirements, particularly in low-resource settings. Robotic-assisted appendectomy shows better ergonomics and recovery benefits but remains cost-prohibitive for global use. In special populations, like pediatric patients and pregnant women, tailored approaches enhance safety and outcomes. However, significant disparities remain in global access to minimally invasive techniques, caused by economic constraints and training gaps in low- and middle-income countries. In clinical practice, laparoscopic appendectomy is advised where expertise exists, with technique selection guided by patient-specific factors like age, pregnancy, and appendicitis severity. Future efforts must prioritize standardized training, funded equipment, diagnostic algorithms to reduce unnecessary surgeries, and rigorous validation of emerging therapies. Collaborative policy and research initiatives are essential to bridge global differences and achieve evidence-based, minimally invasive management of appendicitis in all populations.