Abstract
Background
Mini-invasive techniques have revolutionized surgery, but the superiority of laparoscopic access for appendectomy is widely debated. The authors analyze their monocentric experience with 1,347 laparoscopic appendectomies.
Methods
Between October 1991 and December 2002, all the patients with an indication for appendectomy underwent surgery (301 emergency and 1,046 interval appendectomies) using the laparoscopic approach.
Results
For 1,248 patients, appendectomy was performed laparoscopically, whereas for 99 patients (7.3%), it was converted to an open procedure because of technical reasons (90 patients, 6.7%) or intraoperative complications (9 patients, 0.6%). For 59 patients (4.4%), the appendectomy was associated with another procedure. Histology showed “acute” alterations in 261 of the 301 emergency surgeries and in 148 of the 1,046 elective operations. Postoperative complications arose in 37 patients (2.7%), with 5 patients (0.3%) requiring invasive treatment. The mean postoperative stay was 30 h.
Conclusions
Laparoscopic appendectomy offers unquestionable advantages, but it is not yet considered the “gold standard” for appendiceal pathology. Many centers reserve it for selected patients (e.g., obese patients and women suspected of having other pathologies). No randomized trials or metaanalyses have definitively proved its superiority.
Similar content being viewed by others
References
Anderson DG, Edelman DS (1997) Laparoscopic appendectomy versus open appendectomy: a single-institution study. JSLS 1(4):323–324
Attwood SEA, Hill ADK, Murphy PG (1992) A prospective randomized trial of laparoscopic versus open appendectomy. Surgery 112: 497–501
Chevalier J, Durand A (1980) Reflexions sur une série homogène de 3,200 appendicectomies. Lyon Chir 76: 251–253
Chung RS, Rowland DY, Le P, Diaz J (1999) A metaanalysis of randomized controlled trials of laparoscopic versus conventional appendectomy. Am J Surg 117: 250–256
Cox MR, McCall JL, Toouli J (1996) Prospective randomized comparison of open versus laparoscopic appendectomy in men. World J Surg 20: 263–266
Croce E, Olmi S, Azzola M, Russo R (1999) Laparoscopic appendectomy and minilaparoscopic approach: a retrospective review after eight years’ experience. J Soc Laparoendosc Surg 3: 285–292
European Association for Endoscopic Surgery (1995) The EAES Consensus Development Conferences on laparoscopic cholecystectomy, appendectomy, and hernia repair. Surg Endosc 9: 550–563
Frazee RC, Roberts JW, Symmonds RE (1994) A prospective randomized trial comparing open versus laparoscopic appendectomy. Ann Surg 219: 725–731
Garbutt JM, Soper NJ, Shannon WD, Botero A, Littenberg B (1999) Metaanalysis of controlled trials comparing laparoscopic and open appendectomy. Surg Laparosc Endosc 9: 17–26
Golub R, Siddiqui F, Pohl D (1998) Laparoscopic versus open appendectomy: a metaanalysis. J Am Coll Surg 186: 545–553
Gotz F, Pier A, Bacher C (1990) Modified laparoscopic appendectomy in surgery: a report of 338 operations. Surg Endosc 4: 6–9
Guller U, Hervey S, Purves H, Muhlbaier LH, Peterson ED, Eubanks S, Pietrobon R (2004) Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database. Ann Surg 239: 43–52
Hansen JB, Smithers BM, Schache D (1996) Laparoscopic versus open appendectomy: prospective randomized trial. World J Surg 20: 17–21
Hart R, Rajgopal C, Plews A Sweenwy J, Davies W, Gray D, Taylor B (1996) Laparoscopic versus open appendectomy: a prospective randomized trial of 81 patients. Can J Surg 39: 457–462
Heikkinen TJ, Haukipuro K, Hulkko A (1998) Cost-effective appendectomy: open or laparoscopic? A prospective randomized study. Surg Endosc 12: 1204–1208
Hellberg A, Rudberg C, Kullman E, Enochsson L, Fenyo G, Graffnet H, Hallerback B, Johansson B, Anderberg B, Wenner J, Ringqvist I, Sorensen S (1999) Prospective randomized multicentre study of laparoscopic versus open appendectomy. Br J Surg 86: 48–53
Henle KP, Beller S, Rechener J, Zerz A, Szinic G, Klinger A (1996) Laparoscopic versus conventional appendectomy: a prospective randomized study. Chirurg 67: 526–530
Ignacio RC, Burke R, Spencer D, Bissel C, Dorsainvil C, Lucha PA (2004) Laparoscopic vs open appendectomy: what is the real difference? Results of a prospective randomized double-blinded trial. Surg Endosc 18:334–337
Johnson AB, Peetz ME (1998) Laparoscopic appendectomy is an acceptable alternative for the treatment of perforated appendicitis. Surg Endosc 12: 940–943
Kazemier G, De Zeew GR, Lange JF, Hop WCJ, Bonjer HJ (1997) Laparoscopic vs open appendectomy: a randomized clinical trial. Surg Endosc 11: 336–340
Kluiber RM, Hartsman B (1996) Laparoscopic appendectomy. Dis Colon Rectum 39: 1008–1009
Laine S, Rantala A, Gullichsen R, Ovaska J (1997) Laparoscopic appendectomy: is it worthwhile? Surg Endosc 11: 95–97
Lehmann-Willenbrock E, Mecke H, Riedel HH (1990) Sequelae of appendicectomy with special reference to intraabdominal adhesions, chronic abdominal pain, and infertility. Gynecol Obstet Invest 29: 241–245
Lorenz EP, Ehren G, Schmid M, Soop J, Konradt J (1998) Laparoscopic appendectomy as standard procedure: technique and outcome in 409 patients. Zentralbl Chir 123(Suppl 4): 97–100
Macarulla E, Vallet J, Abad JM, Hussein H, Fernandez E, Nieto B (1997) Laparoscopic versus open appendectomy: a prospective randomized trial. Surg Laparosc Endosc 7: 335–339
Martin LC, Puente I, Sosa JL (1995) Open versus laparoscopic appendectomy. Ann Surg 222: 256–262
Maxwell JG, Robinson CL, Maxwell TG, Maxwell BG, Smith CR, Brinker C (2001) Deriving the indications for laparoscopic appendectomy from comparison of the outcomes of laparoscopic and open appendectomy. Am J Surg 182: 687–692
McCahill LE, Pellegrini CA, Wiggins TBS, Helton SW (1996) A clinical outcome and cost analysis of laparoscopic versus open appendectomy. Am J Surg 171: 533–537
McCall JL, Sharpless K, Jadallah F (1997) Systematic review of randomized controlled trials comparing laparoscopic with open appendicectomy. Br J Surg 84: 1045–1050
Meynaud-Kraemer L, Colin C, Vergnon P, Barth X (1999) Wound infection in open versus laparoscopic appendectomy: a meta-analysis. Int J Tech Assess Health Care 15: 380–391
Oka T, Kurkchubasche AG, Bussey JC, Wesselhoeft CW Jr, Tracy TF Jr, Luks FI (2004) Open and laparascopic appendectomy are equally safe and acceptable in children. Surg Endosc 18: 242–245
Ortega AE, Hunter JC, Peters JH (1995) A prospective, randomized comparison of laparoscopic appendectomy with open appendectomy. Am J Surg 169: 208–213
Ozmen MM, Zulfikaroglu B, Tanik A, Kale IT (1999) Laparoscopic versus open appendectomy: prospective randomized trial. Surg Laparosc Endosc Percutan Tech 9: 187–189
Reiertsen O, Larsen S, Trondsen E (1997) Randomized controlled trial with sequential design of laparoscopic versus conventional appendectomy. Br J Surg 84: 842–847
Roviaro GC, Varoli F, Saguatti L, Vergani C, Maciocco M, Scarduelli A (2002) Major vascular injuries in laparoscopic surgery: still of interest? Surg Endosc 16: 1192–1196
Sauerland S, Lefering R, Halthausen U, Neugebaner EA (1998) Laparoscopic vs conventional appendectomy: a metaanalysis of randomized controlled trials. Langenbecks Arch Surg 383: 289–295
Schafer M, Lauper M, Krahenbulh L (2000) A nation’s experience of bleeding complications during laparoscopy. Am J Surg 180: 73–77
Schirmer BD, Schmierg RE, Dix J, Edge SB, Hanks JB (1993) Laparoscopic versus traditional appendectomy for suspected appendicitis. Am J Surg 165: 670–675
Semm K (1983) Endoscopic appendectomy. Endoscopy 15: 59–64
Slim R, Pezet D, Chipponi J (1998) Laparascopic or open appendectomy? Critical review of randomized controlled trials. Dis Colon Rectum 41: 398–403
Tate JJT, Dawnson JW, Chung SCS, Li AKC (1993) Laparoscopic versus open appendectomy: prospective randomized trial. Lancet 342: 633–637
Temple LK, Litwin DE, McLeod RS (1999) A metaanalysis of laparoscopic versus open appendectomy in patients suspected of having acute appendicitis. Can J Surg 42: 377–383
Ure BM, Bax NM, Van der Zee DC (2000) Laparoscopy in infants and children: a prospective study on feasibility and the impact on routine surgery. J Pediatr Surg 35: 1170–1173
Valla JS, Limonne B, Valla V (1991) Laparoscopic appendectomy in children: report of 465 cases. Surg Laparosc Endosc 3: 166–172
Valla JS, Ordorica Flores RM, Steyaert H, Merrot T, Barteles AM, Brean J, Ginier C, Cheli M (1999) Umbilical one-puncture laparascopic-assisted appendectomy. Surg Endosc 13: 83–85
Valla JS, Steyaert H (1999) Laparoscopic appendicectomy in children in endoscopic surgery. Spinger Verlag, Berlin, New York pp 234–253
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Roviaro, G.C., Vergani, C., Varoli, F. et al. Videolaparoscopic appendectomy: the current outlook. Surg Endosc 20, 1526–1530 (2006). https://doi.org/10.1007/s00464-005-0021-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-005-0021-0