Laparoscopic appendectomy - is it feasible?
Abstract
Introduction: Laparoscopic appendectomy was accepted as a way of treating acute appendicitis in the very dawn of laparoscopic surgery. However, since it is more expensive than open appendectomy, questions were raised regarding its feasibility. There are numerous reports that laparoscopic appendectomy is feasible because of its shortened postoperative recovery, but some studies report equal lengths of hospital stay and recovery time after open and laparoscopic appendectomy. An alternative, extracorporeal method of laparoscopic appendectomy has evolved, that is not as expensive as normal laparoscopic appendectomy, but has greater wound infection rate. Here we present our series of 32 cases of laparoscopically operated appendicitis. Patients and methods: From June 2002 to June 2004 we performed 32 laparoscopic appendectomies, which accounted for 22% of all appendectomies carried out at our department in that period. In 30 cases, the diagnosis was acute appendicitis, and in two cases chronic appendicitis with palpable perityphlitic infiltrate. We used a 3-trocar technique. The appendix was resected using an endo-GIA stapling device. If the appendix was gangrenous or perforated, we extracted it using an endo-pouch device. Results: We were able to successfully carry out all the operations, without a single conversion to open procedure. Postoperatively, we had only two complications: one paralytic ileus, resolved conservatively, and one postoperative bleeding from a trocar insertion site, that required surgical intervention through 5 cm minilaparotomy. Average length of hospital stay was four days. The patients averagely spent only nine days on sick leave. Only one patient used analgetics after hospital discharge, others were without pane. At a later control examination, all the patients and the surgeon rated the postoperative scars as excellent. Discussion: In our series we successfully performed all laparoscopic appendectomies, without conversions. We only had two complications, and no surgical wound infections, a complication that is most frequent after appendectomy. Length of hospital stay was shorter than after open appendectomy, and average sick leave was shorter than reported sick leave after open appendectomy. Therefore we can only conclude that laparoscopic appendectomy has an outcome which is superior to that of open appendectomy. We therefore suggest that laparoscopic appendectomy is the method of choice for acute appendicitis, regardless of the severity of disease.
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