Page 21 - World Journal of Laparoscopic Surgery

World Journal of Laparoscopic Surgery, January-April 2008;1(1):19-28
Laparoscopic versus Open Appendectomy for the Treatment of Acute Appendicitis
Laparoscopic versus Open Appendectomy

for the Treatment of Acute Appendicitis

RK Mishra, GB Hanna, A Cuschieri
Surgical skills Unit: Department of Surgery and Molecular oncology, Ninewells Hospital and Medical School,
University of Dundee

Abstract: Open appendectomy is the ‘gold standard’ for the treatment 6. Time until resumption of diet
of acute appendicitis. Laparoscopic appendectomy though widely 7. Postoperative morbidity
practiced has not gained universal approval. Although it is a generally 8. Hospital stay
safe operation, postoperative complications occur in few patients. 9. Cost effectiveness and
Laparoscopic appendectomy was first described in 1983. Reports of 10. Quality of life analyses.
early studies were equivocal with few studies evaluating analgesic
requirements and the length of hospital stay. This study was aimed to
compare laparoscopic with open appendectomy and ascertain the MATERIALS AND METHODS
therapeutic benefit, if any, in the overall management of acute
appendicitis. A literature search was performed using Medline and the search
engine Google. The following search terms were used: “laparos-
Keywords: Laparoscopic appendectomy, Appendectomy, copic appendectomy”, “appendicitis”, and “appendicectomy”.
Appendicitis, Laparoscopic vs open appendectomy. 3400 citations found in total. Selected papers were screened for
further references. Criteria for selection of literature were the
INTRODUCTION number of cases (excluded if less than 20), methods of analysis
(statistical or nonstatistical), operative procedure (only
Appendicitis was first recognized as a disease entity in the universally accepted procedures were selected) and the
sixteenth century and was called perityphlitis. McBurney Institution where the study was done (Specialized institution
described the clinical findings in 1889. Minimal access surgery for laparoscopic surgery).
has been proved to be a useful surgical technique. New
standards have been established for various indications. Patient CONTENT
comfort is a greater consideration in the 21st century. The
acquisition of recent technology and skills now affords a better Evolution of Laparoscopic Appendicectomy
choice of the mode of surgery. This document reviews the recent Laparoscopic appendectomy is being done at a time when
advances in treatment technique applicable to laparoscopic laparoscopic cholecystectomy has shown definite benefits over
appendectomy, examines the literature, and suggests guidelines the open technique. In the young female the cause of lower
for laparoscopic intervention in patients with acute appendicitis.
abdominal pain is often gynecological. Gynecologists perform
diagnostic laparoscopy frequently. Semm, a German gyneco-
AIMS
logist, performed the first laparoscopic appendectomy in 1983.
The aim of this study was to compare the effectiveness and Laparoscopic cholecystectomy is now the gold standard
safety of laparoscopic and conventional “open” appendectomy for cholelithiasis and has virtually replaced open chole-
in the treatment of acute appendicitis. The following parameters cystectomy. However, is this the case for acute appendicitis?
were evaluated for both laparoscopic and open procedures. The role of laparoscopic appendectomy has not yet been clearly
1. Method of patient selection defined. Laparoscopic surgery continues to evolve at such a
2. Operative technique rapid pace that it is now time to examine the latest developments
3. Operating time with regard to acute appendicitis. Numerous factors need to be
4. Intraoperative and postoperative complications considered in deciding the ideal, and most appropriate surgical
5. Postoperative pain and amount of narcotic used technique for acute appendicitis.

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