Since 1975, the Department of Surgery in the Grevenbroich Community Hospital (Germany) has applied a simplified technique of open appendectomy. The inhouse modified procedure without stump embedding has been performed in 3,448 cases to date. The same approach has been used in 1,463 laparoscopic appendectomies since 1991. In the laparoscopic procedure the stump is ligated solely with Roeder's loop. None of the 4,911 patients who have undergone either open or laparoscopic appendectomy have developed stump inadequacy or stercoral fistulae. According to the special literature, the complication rate after appendectomies without stump embedding is lower than that after standard procedures. In retrospect, laparoscopic appendectomy with simple ligation has confirmed the results achieved with simple ligation in open appendectomies. The technique should therefore become more common practice in open appendectomies, as well.

Since January 1981, the so-called "3-day principle" in cases of suspected appendicitis has been applied in order to render the indications for surgery more precise. The retrospective analysis of a total of 1877 appendectomies performed between 1981 and 1990 demonstrated that the majority of histologically definite cases of acute appendicitis had been surgically treated on the day of admission to hospital. Furthermore, a second peak of histologically evident cases of acute appendicitis was seen with non-characteristic symptoms on the 3rd day. An additional remarkable finding was that 38.0% (!) of all appendices intraoperatively declared to be "innocent" showed histologically definite inflammatory alterations.