[Appendectomy 1997--open or closed?].

Abstract

Unlike laparoscopic cholecystectomy, laparoscopic appendectomy (LAE) has not yet become popular. Are there no significant advantages? Or is the poor acceptance of LAE related to its longer learning curve, longer operative times and the need for additional equipment, which lead to some inconvenience when the procedure is done on an emergency basis? LAE may be performed as safely as open appendectomy (OAE) with fewer wound complications. Superior laparoscopic exploration allows an accurate diagnosis and reduces the rate of negative appendectomies. In contrast, postoperative pain, recovery and the cosmetic result are equal to or at best slightly better than in open surgery. Therefore, in the routine patients, there is no need to replace OAE by LAE. In the case of an uncertain diagnosis, the laparoscopic approach is generally superior, allowing thorough abdominal exploration. This has to be considered in each individual case; however, women with lower abdominal pain and suspected appendicitis will certainly benefit from laparoscopy, as well as older patients with an unclear diagnosis. The lower rate of wound infections is beneficial to obese patients and to patients with gangrenous or perforated appendicitis. Furthermore, the decision for one procedure or the other is influenced by the patient's individual preference and cosmetic aspects. The verifiable benefit of the laparoscopic procedure for certain categories of patients and the potential advantages in the individual case suggest that competent handling of laparoscopic technology will be required in future. Therefore, experienced surgeons should take more active interest in instruction and training--even when surgery has to be performed after hours.