Laparoscopic appendectomy in Switzerland: a prospective audit of 2, 179 cases.
OBJECTIVE
Since its introduction in 1983, laparoscopic appendectomy (LA) has not replaced the conventional open procedure. The patient benefit seems limited to a decreased wound infection rate, and the overall morbidity and mortality rates remain equal to those of open appendectomy.


METHODS
The data (collected by the Swiss Association of Laparoscopic and Thoracoscopic Surgery) from 2, 179 patients undergoing LA at 84 surgical institutions in Switzerland between January 1995 and December 1997 were retrospectively analyzed.


RESULTS
More than 90% of all patients had no intra- or postoperative complications. However, perforated appendicitis was associated with more complications, in particular a threefold increased wound infection rate (9.2 vs 3.5%). Furthermore, the conversion and reoperation rates of perforated appendicitis were significantly increased compared to 'simple' acute appendicitis (25. 5 and 10.4% vs 4.8 and 2.1%, respectively). LA performed with a stapling device is superior to LA performed with loops, although the difference is not significant.


CONCLUSIONS
Therefore, LA is a safe and effective procedure. The postoperative morbidity and mortality rates are comparable to those of open appendectomy, which is still the most commonly used procedure in Switzerland. The question of whether perforated appendicitis is better treated laparoscopically or by the open procedure cannot be answered with our data.
Schäfer
M
M
Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS), Inselspital, University of Bern, Switzerland.
Krähenbühl
L
L
Frei
E
E
Büchler
M W
MW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery; D007431:Intraoperative Complications; D010535:Laparoscopy; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D017792:Surgical Stapling; D013530:Surgical Wound Infection / Q000209:etiology; D013557:Switzerland; D016896:Treatment Outcome