[The justification for laparoscopic appendectomy]

Abstract

Laparoscopic appendicectomy (LA), in contrast to open appendicectomy (OA), is not generally accepted as the treatment of choice for suspected appendicitis because it is technically difficult, not readily available everywhere, takes longer to perform, is expensive, and is associated with an increased incidence of intra-abdominal abscesses. However, LA has shown a superior outcome compared to an OA in terms of less postoperative pain, earlier hospital discharge, quicker return to normal activity and work and decreased incidence of wound infection. Furthermore, a diagnostic laparoscopy is valuable in case of an equivocal diagnosis of appendicitis especially in premenopausal women and obese individuals because it allows a thorough examination of the whole abdomen under direct vision. It, therefore, permits accurate diagnosis and hence reduces the negative appendectomy rate. Nevertheless, before endorsing routine and widespread use of LA, it is essential that this technique is critically evaluated in well designed, controlled, randomised, prospective trials clearly showing major benefits to the patient in terms of quicker hospital discharge, reduced postoperative pain, decreased wound infection and early return to full activities.