[Laparoscopic appendectomy. The new standard?].
Since the introduction of laparoscopic appendectomy by Semm in 1983, the role of this minimally invasive surgical technique has been the focus of controversial discussion. Meta-analyses have identified its advantages as having significantly lower wound infection rates, less postoperative pain and earlier resumption of normal everyday activities. The disadvantages are higher rates of intra-abdominal abscesses, longer operating times and higher inpatient treatment costs. However, some of the advantages identified by meta-analyses have been called into question by the results obtained from research into aspects of care. These discrepancies are attributable to the different surgeons involved in the various studies. The results are greatly influenced by the qualifications and experience of the surgeons. Therefore conventional appendectomy using a right lower lateral McBurney incision should continue to be the gold standard. Surgeons who have extensive experience in the field of laparoscopic surgery can achieve better results with minimally invasive appendectomy than with open surgery. This also holds true for specific situations such as complicated appendicitis and for morbidly obese patients. However, the operating costs incurred for laparoscopic appendectomy are higher because it has been shown that removal of the appendix with a linear stapler is the most reliable method.
Köckerling
F
F
Klinik für Chirurgie - Visceral- und Gefässchirurgie, Vivantes Klinikum Spandau, Neue Bergstrasse 6, Berlin, Germany. ferdinand.koeckerling@vivantes.de
Schug-Pass
C
C
Grund
S
S
D000328:Adult; D001062:Appendectomy / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D015201:Meta-Analysis as Topic; D011183:Postoperative Complications / Q000517:prevention & control; D012106:Research; D013996:Time and Motion Studies; D016896:Treatment Outcome