The Evolution of the Appendectomy: From Open to Laparoscopic to Single Incision

Abstract

Beginning with its initial description by Fitz in the 19th century, acute appendicitis has been a significant long-standing medical challenge; today it remains the most common gastrointestinal emergency in adults. Already in 1894, McBurney advocated for the surgical removal of the inflamed appendix and is credited with the initial description of an Open Appendectomy (OA). With the introduction of minimally invasive surgery, this classic approach evolved into a procedure with multiple, smaller incisions; a technique termed Laparoscopic Appendectomy (LA). There is much literature describing the advantages of this newer approach. To name a few, patients have significantly less wound infections, reduced pain, and a reduction in ileus compared with the OA. In the past few years, Single Incision Laparoscopic Appendectomy (SILA) has gained popularity as the next major evolutionary advancement in the removal of the appendix. Described as a pioneer in the era of “scarless surgery,” it involves only one transumbilical incision. Patients are postulated to have reduced post-operative complications such as infection, hernias, and hematomas, as well as a quicker recovery time and less post-operative pain scores, in comparison to its predecessors. In this review, we explore the advancement of the appendectomy from open to laparoscopic to single incision.

Open versus laparoscopic appendectomy among Saudi patients

“…McBurney has been credited the surgical technique of the open appendectomy in 1894, which has not significantly changed in the last 120 years. 12 OA approaches can be briefly described as it involves making a 5 cm incision at the lateral border of the right rectus muscle at the midpoint between the umbilicus and right anterior-superior iliac spine. Blunt dissection and electrocautery are used to separate the fascia from muscles, and the peritoneum is then opened.…”

Laparoscopic Versus Open Appendectomy: A Retrospective Comparative Study.

“…Appendectomy is the one of most commonly performed urgent abdominal surgeries (1) , with a lifetime incidence of about 8%.…”

“…(1) There are many surgical techniques for treating appendicitis, the first surgeon to successfully perform appendectomy was Claudius Amyand in 1735, at St. George's Hospital in London. (2) The patient was an 11-year-old boy who had swallowed a pin that perforated his appendix.…”

“…Charles McBurnery was the first to describe and consolidate the approach for open appendectomy in 1894, (1) and it has not changed significantly since then. (1) In 1981, Kurt Semm performed the first laparoscopic appendectomy, and since then, the surgeons slowly shifted away from the open method to the laparoscopic method.…”

“…(1) In 1981, Kurt Semm performed the first laparoscopic appendectomy, and since then, the surgeons slowly shifted away from the open method to the laparoscopic method. The laparoscopic approach involves three ports placed at the umbilicus-A 10 millimeter camera port-, and two 5 millimeter ports placed in the right iliac fossa and the right hypochondriac quadrant.…”