[Is open appendectomy still up-to-date?].
The acceptance of the laparoscopic technique for appendectomy can't be compared with the success in laparoscopic cholecystectomy. The discussion is still controversial. A lower rate of wound infection in comparison to open appendectomy has been proven statistically in many studies. There is no evidence of a higher rate of complications. Postoperative pain may be reduced and return to work is often earlier. Cosmesis shows better results. Operation time and hospital stay are comparable to open appendectomy. The total of direct and indirect costs is not higher with laparoscopic than with open appendectomy. Excellent indications for laparoscopic appendectomy are atypical pain in the right lower abdomen, uncertain diagnosis in fertile and elderly women, obesity and complicated appendicitis. Controlled double-blinded randomized studies are necessary in the future to define the advantages and further indications.
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Chirurgische Klinik, Stadtspital Waid, Zürich. remo.naef@waid.stzh.ch
Buchmann
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D000328:Adult; D000367:Age Factors; D000368:Aged; D001062:Appendectomy / Q000191:economics / Q000379:methods*; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D003365:Costs and Cost Analysis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D010149:Postoperative Pain / Q000453:epidemiology; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013530:Surgical Wound Infection / Q000453:epidemiology; D013997:Time Factors