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Techniques in Coloproctology

, Volume 15, Issue 1, pp 1–6 | Cite as

A brief review of laparoscopic appendectomy: the issues and the evidence

  • N. VettorettoEmail author
  • F. Agresta
Review

Abstract

Laparoscopic appendectomy was first performed more than 25 years ago. We performed a systematic literature search on laparoscopic appendectomy and selected related topics. The technique should be considered the gold standard for surgical removal of the appendix in women of childbearing age (level of evidence Ia). There is minor but consistent evidence that it should also be advocated for men (level of evidence III), obese (level of evidence III), and elderly (level of evidence IIb) patients, while there is some evidence of unfavorable results on pregnant women (level of evidence IIb). Studies reporting higher incidence of intra-abdominal abscesses after laparoscopic appendectomy are difficult to interpret due to a lack of standardization of the operative technique and lack of uniformity related to the different grades of disease (ranging from uninflamed appendix to diffuse peritonitis, gangrene, or perforation of the organ). As far as surgical technique, the three-port procedure is superior to needleoscopy and single port access (level of evidence Ia). Costly high-tech instruments for dissection are mostly unnecessary (level Ib). Mechanical closure of the stump might prove safer (level Ib). The quantity of peritoneal lavage fluid is generally scanty (level III), and abdominal drains are not useful (level Ia). Fast-track protocols should be implemented (level Ic). Training and technical standardization are the key to devising future trials on this topic.

Keywords

Laparoscopic appendectomy Complications Technique 

Notes

Acknowledgments

The authors thank Mrs. Janette Hanney for the linguistic support.

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Laparoscopic Surgery Unit, Department of SurgeryM. Mellini HospitalChiariItaly
  2. 2.Department of General SurgeryOspedale CivileVittorio VenetoItaly
  3. 3.UOS Chirurgia LaparoscopicaChirurgia GeneraleChiariItaly

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