Laparoscopic versus open surgery for suspected appendicitis

Laparoscopic Appendectomy

“…Nevertheless, all meta-analyses agree that the duration of surgery is longer in laparoscopic appendectomy (Benett, 2007;Chung et al, 1999;Fingerhut et al, 1999;Garbutt et al, 1999;Golub et al, 1998;Sauerland et al, 2010;Temple et al, 1999). It is nonetheless remarkable that -as laparoscopy evolves -the results of meta-analyses performed by the same investigators show through the years a decreasing difference in operating time between the two approaches (Sauerland et al, 1998(Sauerland et al, , 2002(Sauerland et al, , 2004(Sauerland et al, , 2010. Sauerland et al report in their most recent meta-analysis that laparoscopic appendectomy is on the average 10 minutes longer than the open one (Sauerland et al, 2010).…”

“…In the literature negative laparotomies in suspected acute appendicitis typically range between 20-30%, while the typical range for negative laparoscopies is 10-15% (Tate, 1996). Especially in the subgroup of fertile females authors report a negative laparotomy rate between 22-40% and a negative laparoscopy rate between 4-17% and (Sauerland et al, 2004). We assume that in experienced hands a negative laparoscopy is truly negative -at least concerning the macroscopic findings-whereas a negative laparotomy with a Mc Burney incision fails to diagnose the pathology in about half of the cases as can be confirmed by the numbers.…”

“…Especially during the last twenty years there have been over 60 randomized controlled trials comparing laparoscopic and open appendectomy in adults (Vettoretto et al, 2010) as well as many meta-analyses of randomized controlled trials (Bennett et al, 2007;Chung et al, 1999;Fingerhut et al, 1999;Garbutt et al, 1999;Golub et al, 1998;Liu et al, 2010;Sauerland et al, 1998Sauerland et al, , 2002Sauerland et al, , 2004Sauerland et al, , 2010. The number of publications on laparoscopic appendectomy is still increasing, while publications on laparoscopic cholecystectomy decline.…”

“…Conversion rate ranges in meta-analyses between 0% and 23% (Lippert et al, 2002;Sauerland et al, 2004) but there are studies which report conversion rates as high as 39% (Moberg et al, 1998). In everyday praxis conversion rate typically seems to range between 10 and 20%, while in centers of excellence it is lower than 2%.…”

“…Mean operating times in meta-analyses of randomised trials range between 23,5 and 102,2 min (Sauerland et al, 2004). Apart from differences in laparoscopic experience, this can be attributed to the different definitions of operating time.…”