Appendectomy in Switzerland: how is it done?

  • Nicolas M. Obrist
  • Christoph Tschuor
  • Stefan Breitenstein
  • Raphael N. Vuille-dit-Bille
  • Christopher SollEmail author
Original Article


More than 10,000 appendectomies are performed every year in Switzerland. The aim of this study was to investigate the treatment strategy for appendicitis among Swiss surgeons with particular interest in laparoscopic technique, method of appendiceal stump closure, and abdominal lavage. We performed an anonymous survey among 540 members of the Swiss Surgical Society. Technical details and differences between the surgical procedures in adults and children as well as in complicated and non-complicated appendicitis were investigated. The overall response rate was 45% (n = 243). 78% of the surgeons perform laparoscopic appendectomies in children and 95% in adult patients. Only 3% use a single incision site technique. Surgeons consider pus or stool in the abdomen (94%), an abscess (86%) or perforation of the appendix (82%), but not an inflamed appendiceal base (16%) as complicated appendicitis. 41% of surgeons use endoloops, 36% a stapling device, and 20% polymeric clips in non-complicated appendicitis for appendiceal stump closure. However, 82% of the surgeons use a stapler in complicated appendicitis. Most (76%) of surgeons do not plunge the appendiceal stump. 24% of surgeons lavage the abdomen with > 1 L of fluid independent of the intraabdominal finding. Most Swiss surgeons perform multiport laparoscopic appendectomies. Endoloops and staplers are mostly used for appendiceal stump closures in uncomplicated appendicitis, and staplers in complicated appendicitis. Only a minor part of surgeons plunge the appendiceal stump or perform routine abdominal lavage.


Appendicitis Surgery Treatment Switzerland 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

The research did not involve human participant or animals.

Informed consent

Not applicable for this type of study.

Supplementary material

13304_2019_654_MOESM1_ESM.docx (35 kb)
Supplementary material 1 (DOCX 34 kb)


  1. 1.
    Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 132(5):910–925 (PubMed PMID: 2239906. Epub 1990/11/01) CrossRefGoogle Scholar
  2. 2.
    BFS BfS. Spitalaufenthalte 2008 Ausgewählte Ergebnisse. CH-2010 Neuchàtel: Bundesamt für Statistik der Schweizerischen Eidgenossenschaft; 2008. Accessed 05 Feb 2018
  3. 3.
    McBurney C IV (1894) The incision made in the abdominal wall in cases of appendicitis, with a description of a new method of operating. Ann Surg 20(1):38–43 (PubMed PMID: 17860070. Pubmed Central PMCID: PMC1493708. Epub 1894/07/01) CrossRefGoogle Scholar
  4. 4.
    Li X, Zhang J, Sang L, Zhang W, Chu Z, Li X et al (2010) Laparoscopic versus conventional appendectomy—a meta-analysis of randomized controlled trials. BMC Gastroenterol 10:129 (PubMed PMID: 21047410. Pubmed Central PMCID: 2988072) CrossRefGoogle Scholar
  5. 5.
    Semm K (1983) Endoscopic appendectomy. Endoscopy 15(2):59–64 (PubMed PMID: 6221925) CrossRefGoogle Scholar
  6. 6.
    Litynski GS (1998) Kurt Semm and the fight against skepticism: endoscopic hemostasis, laparoscopic appendectomy, and Semm’s impact on the “laparoscopic revolution”. JSLS 2(3):309–313 (PubMed PMID: 9876762. Pubmed Central PMCID: PMC3015306) Google Scholar
  7. 7.
    Parikh PP, Tashiro J, Wagenaar AE, Curbelo M, Perez EA, Neville HL et al (2018) Looped suture versus stapler device in pediatric laparoscopic appendectomy: a comparative outcomes and intraoperative cost analysis. J Pediatr Surg. 53(4):616–619 (PubMed PMID: 28550935. Epub 2017/05/30) CrossRefGoogle Scholar
  8. 8.
    Soll C, Wyss P, Gelpke H, Raptis DA, Breitenstein S (2016) Appendiceal stump closure using polymeric clips reduces intra-abdominal abscesses. Langenbecks Arch Surg 401(5):661–666 PubMed PMID: 27294658 CrossRefGoogle Scholar
  9. 9.
    Akkoyun I, Tuna AT (2012) Advantages of abandoning abdominal cavity irrigation and drainage in operations performed on children with perforated appendicitis. J Pediatr Surg 47(10):1886–1890 (PubMed PMID: 23084202. Epub 2012/10/23) CrossRefGoogle Scholar
  10. 10.
    Hartwich JE, Carter RF, Wolfe L, Goretsky M, Heath K, St Peter SD et al (2013) The effects of irrigation on outcomes in cases of perforated appendicitis in children. J Surg Res 180(2):222–225 (PubMed PMID: 22595016. Epub 2012/05/19) CrossRefGoogle Scholar
  11. 11.
    Snow HA, Choi JM, Cheng MW, Chan ST (2016) Irrigation versus suction alone during laparoscopic appendectomy; a randomized controlled equivalence trial. Int J Surg 28:91–96 (PubMed PMID: 26912015. Epub 2016/02/26) CrossRefGoogle Scholar
  12. 12.
    Agresta F, Ansaloni L, Baiocchi GL, Bergamini C, Campanile FC, Carlucci M et al (2012) Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Societa Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Societa Italiana di Chirurgia (SIC), Societa Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Societa Italiana di Chirurgia nell’Ospedalita Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc 26(8):2134–2164 (PubMed PMID: 22736283) CrossRefGoogle Scholar
  13. 13.
    Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M et al (2016) WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg 11:34 (PubMed PMID: 27437029. Pubmed Central PMCID: PMC4949879. Epub 2016/07/21) CrossRefGoogle Scholar
  14. 14.
    Esposito C, Calvo AI, Castagnetti M, Alicchio F, Suarez C, Giurin I et al (2012) Open versus laparoscopic appendectomy in the pediatric population: a literature review and analysis of complications. J Laparoendosc Adv Surg Tech A 22(8):834–839 (PubMed PMID: 23039707. Epub 2012/10/09) CrossRefGoogle Scholar
  15. 15.
    Ferzli GS, Fingerhut A (2004) Trocar placement for laparoscopic abdominal procedures: a simple standardized method. J Am Coll Surg 198(1):163–173 (PubMed PMID: 14698326. Epub 2003/12/31) CrossRefGoogle Scholar
  16. 16.
    Buckley CE, Kavanagh DO, Gallagher TK, Conroy RM, Traynor OJ, Neary PC (2013) Does aptitude influence the rate at which proficiency is achieved for laparoscopic appendectomy? J Am Coll Surg 217(6):1020–1027 (PubMed PMID: 24051067. Epub 2013/09/21) CrossRefGoogle Scholar
  17. 17.
    Aly OE, Black DH, Rehman H, Ahmed I (2016) Single incision laparoscopic appendicectomy versus conventional three-port laparoscopic appendicectomy: a systematic review and meta-analysis. Int J Surg 35:120–128 (PubMed PMID: 27686264. Epub 2016/10/25) CrossRefGoogle Scholar
  18. 18.
    Clerveus M, Morandeira-Rivas A, Moreno-Sanz C, Herrero-Bogajo ML, Picazo-Yeste JS, Tadeo-Ruiz G (2014) Systematic review and meta-analysis of randomized controlled trials comparing single incision versus conventional laparoscopic appendectomy. World J Surg 38(8):1937–1946 (PubMed PMID: 24682257. Epub 2014/04/01) CrossRefGoogle Scholar
  19. 19.
    Akkoyun I, Akbiyik F (2012) Closing the appendicular stump with a polymeric clip in laparoscopic appendectomy: analysis of 121 pediatric patients. Eur J Pediatr Surg 22(2):133–135 (PubMed PMID: 22517519) CrossRefGoogle Scholar
  20. 20.
    Colak E, Kement M, Ozlem N, Mutlu T, Yildirim K, Gurer A et al (2013) A comparison of nonabsorbable polymeric clips and endoloop ligatures for the closure of the appendicular stump in laparoscopic appendectomy: a prospective, randomized study. Surg Laparosc Endosc Percutan Tech 23(3):255–258 (PubMed PMID: 23751988. Epub 2013/06/12. eng) CrossRefGoogle Scholar
  21. 21.
    Beldi G, Vorburger SA, Bruegger LE, Kocher T, Inderbitzin D, Candinas D (2006) Analysis of stapling versus endoloops in appendiceal stump closure. Br J Surg 93(11):1390–1393 (PubMed PMID: 16862615. Epub 2006/07/25. eng) CrossRefGoogle Scholar
  22. 22.
    Miyano G, Urao M, Lane GJ, Kato Y, Okazaki T, Yamataka A (2011) A prospective analysis of endoloops and endostaples for closing the stump of the appendix in children. J Laparoendosc Adv Surg Tech A 21(2):177–179 (PubMed PMID: 21214418) CrossRefGoogle Scholar
  23. 23.
    Mannu GS, Sudul MK, Bettencourt-Silva JH, Cumber E, Li F, Clark AB et al (2017) Closure methods of the appendix stump for complications during laparoscopic appendectomy. Cochrane Database Syst Rev 11:CD006437 (PubMed PMID: 29190038) Google Scholar
  24. 24.
    Mayir B, Ensari CO, Bilecik T, Aslaner A, Oruc MT (2015) Methods for closure of appendix stump during laparoscopic appendectomy procedure. Ulus Cerrahi Derg. 31(4):229–231 (PubMed PMID: 26668532. Pubmed Central PMCID: PMC4674045) Google Scholar
  25. 25.
    St Peter SD, Adibe OO, Iqbal CW, Fike FB, Sharp SW, Juang D et al (2012) Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis: a prospective randomized trial. Ann Surg 256(4):581–585 (PubMed PMID: 22964730. Epub 2012/09/12) CrossRefGoogle Scholar
  26. 26.
    Cunningham CT, Quan H, Hemmelgarn B, Noseworthy T, Beck CA, Dixon E et al (2015) Exploring physician specialist response rates to web-based surveys. BMC Med Res Methodol 15:32 (PubMed PMID: 25888346. Pubmed Central PMCID: PMC4404667. Epub 2015/04/19) CrossRefGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2019

Authors and Affiliations

  • Nicolas M. Obrist
    • 1
  • Christoph Tschuor
    • 1
  • Stefan Breitenstein
    • 1
  • Raphael N. Vuille-dit-Bille
    • 1
  • Christopher Soll
    • 1
    Email author
  1. 1.Department of Visceral and Thoracic SurgeryCantonal Hospital WinterthurWinterthurSwitzerland

Personalised recommendations