Laparoscopic Appendectomy in Switzerland: A Prospective Audit of 2,179 Cases

Abstract

Background/Aims: Since its introduction in 1983, laparoscopic appendectomy (LA) has not replaced the conventional open procedure. The patient benefit seems limited to a decreased wound infection rate, and the overall morbidity and mortality rates remain equal to those of open appendectomy. Methods: The data (collected by the Swiss Association of Laparoscopic and Thoracoscopic Surgery) from 2,179 patients undergoing LA at 84 surgical institutions in Switzerland between January 1995 and December 1997 were retrospectively analyzed. Results: More than 90% of all patients had no intra- or postoperative complications. However, perforated appendicitis was associated with more complications, in particular a threefold increased wound infection rate (9.2 vs 3.5%). Furthermore, the conversion and reoperation rates of perforated appendicitis were significantly increased compared to ’simple’ acute appendicitis (25.5 and 10.4% vs 4.8 and 2.1%, respectively). LA performed with a stapling device is superior to LA performed with loops, although the difference is not significant. Conclusion: Therefore, LA is a safe and effective procedure. The postoperative morbidity and mortality rates are comparable to those of open appendectomy, which is still the most commonly used procedure in Switzerland. The question of whether perforated appendicitis is better treated laparoscopically or by the open procedure cannot be answered with our data.

Laparoscopic appendicectomy is associated with a lower complication rate even during the introductory phase

“…Since Semm performed the first laparoscopic appendicectomy, numerous studies have shown conflicting results regarding the clinical benefit of this procedure. Most studies in recent years comprise between 50 and 150 patients [5][6][7][8][9], and only a minority have compared 200 or more [10][11][12]. Most of these studies are primarily designed to compare postoperative activity and time course for convalescence.…”

Securing the appendiceal stump in laparoscopic appendectomy: evidence for routine stapling?

“…After the introduction of laparoscopic linear staplers, it became ''en vogue'' to apply these in LA, particularly for difficult cases such as perforation at the appendiceal base [4,5,11]. Currently, some authors advise the routine use of linear staplers during LA to avoid leakage from the appendiceal stump [24].…”

Specimen Retrieval in Laparoscopic Colon Surgery

“…after appendectomy or segmental colon resection) complete retrieval bags such as the lap-sac or the endo-catch systems can be used [11]. These systems offer a convenient handling of the resected specimen without the risk of any further contamination if the specimen is accidentally opened during retrieval.…”

“…To date all open procedures for benign as well as malignant colon diseases have also been performed laparoscopically or laparoscopically assisted [1, 2, 3, 4, 5, 6, 7, 8]. The most frequent procedures described in the literature are ileocecal resection, left or right hemicolectomy [4, 9, 10, 11], sigmoid resection [2, 5]and colectomy with ileoanal anastomosis [12]. Low anterior rectum resection and abdomino-perineal rectum excisions are described less frequently [13].…”