A brief review of laparoscopic appendectomy: the issues and the evidence

Abstract

Laparoscopic appendectomy was first performed more than 25 years ago. We performed a systematic literature search on laparoscopic appendectomy and selected related topics. The technique should be considered the gold standard for surgical removal of the appendix in women of childbearing age (level of evidence Ia). There is minor but consistent evidence that it should also be advocated for men (level of evidence III), obese (level of evidence III), and elderly (level of evidence IIb) patients, while there is some evidence of unfavorable results on pregnant women (level of evidence IIb). Studies reporting higher incidence of intra-abdominal abscesses after laparoscopic appendectomy are difficult to interpret due to a lack of standardization of the operative technique and lack of uniformity related to the different grades of disease (ranging from uninflamed appendix to diffuse peritonitis, gangrene, or perforation of the organ). As far as surgical technique, the three-port procedure is superior to needleoscopy and single port access (level of evidence Ia). Costly high-tech instruments for dissection are mostly unnecessary (level Ib). Mechanical closure of the stump might prove safer (level Ib). The quantity of peritoneal lavage fluid is generally scanty (level III), and abdominal drains are not useful (level Ia). Fast-track protocols should be implemented (level Ic). Training and technical standardization are the key to devising future trials on this topic.

Conventional Laparoscopic Appendicectomy and Laparoscope-Assisted Appendicectomy: a Comparative Study

“…LA has proved to be clearly beneficial in obese and women of reproductive age group and in patients with diagnostic dilemma [6,7]. It is also gaining popularity because of shorter operative time, less postoperative pain, and lesser incidence of surgical site infection [8][9][10][11][12][13][14].…”

Transumbilical laparoscopically assisted appendectomy in children: the results of a single-port, single-channel procedure

“…Conventional LA for acute appendicitis was first described in the early 1980s [1]. Compared with OA, conventional LA reduces postoperative pain and allows early food intake, which shortens the hospital stay.…”

“…The first laparoscopic appendectomy (LA) for acute appendicitis was performed by Semm in 1981 [1]. Since then, LA has become the most common approach for appendicitis at many institutions, even for children [2,3].…”

Single Incision Laparoscopic Surgery Development at the Hospital Clinic: Our 4-Year Experience

“…About postoperative pain, all procedures positively compared with wellanalyzed series describing these procedures performed by conventional laparoscopy [1]. Also, SILS appendectomies and cholecystectomies had a similar length of stay than previously published laparoscopic results [2] [3]. For these reasons, we believe that progression from appendectomies to cholecystectomies and then to more complex procedures like left adrenalectomies in a procedural stepwise manner should be recommended to obtain good intraoperative and postoperative outcomes when introducing a SILS program at any institution.…”