From the Guidelines
Yes, an appendectomy is typically performed laparoscopically in modern medical practice. This minimally invasive approach has become the standard of care for most appendicitis cases, as it offers significant advantages over traditional open surgery, including less post-operative pain, shorter hospital stays, faster recovery, smaller scars, and lower rates of wound infection 1. During a laparoscopic appendectomy, surgeons make 2-3 small incisions in the abdomen, insert a camera (laparoscope) and specialized instruments, and remove the inflamed appendix.
Key Points to Consider
- The procedure generally takes 30-60 minutes under general anesthesia.
- Laparoscopic appendectomy is recommended as the preferred approach over open appendectomy for both uncomplicated and complicated acute appendicitis, where laparoscopic equipment and expertise are available 1.
- Conventional three-port laparoscopic appendectomy is recommended over single-incision laparoscopic appendectomy, as it is associated with shorter operative times, less postoperative pain, and lower incidence of wound infection 1.
- Outpatient laparoscopic appendectomy for uncomplicated acute appendicitis is feasible and safe, without any difference in morbidity 1.
Special Considerations
- In certain situations, such as severe infection with abscess formation, pregnancy, or previous abdominal surgeries, an open appendectomy might be preferred, with the decision based on the patient's specific condition and medical history 1.
- Laparoscopic appendectomy is suggested in obese patients, older patients, and patients with high peri- and postoperative risk factors, as it seems to show relevant advantages compared to open appendectomy in these groups 1.
- The use of wound ring protectors is recommended in open appendectomy to decrease the risk of surgical site infection, especially in cases of complicated appendicitis with contaminated or dirty wounds 1.
From the Research
Laparoscopic Appendectomy
- Laparoscopic appendectomy is a widely accepted treatment for acute appendicitis, offering benefits such as less pain, shorter hospital stay, and quicker return to activities 2, 3, 4.
- The procedure can be performed safely in selected patients on an outpatient basis, with a high rate of success, low morbidity, and low readmission rate 4, 5.
- Laparoscopic appendectomy is superior to open appendectomy in terms of hospital stay, postoperative complications, and return to normal activities, making it the recommended approach for the management of acute appendicitis 2, 6.
Comparison with Open Appendectomy
- Studies have shown that laparoscopic appendectomy has a lower rate of postoperative complications, such as wound infections and intra-abdominal infections, compared to open appendectomy 2, 3, 6.
- Laparoscopic appendectomy also results in a shorter hospital stay and faster return to normal activities compared to open appendectomy 2, 3, 6.
- However, laparoscopic appendectomy may be associated with an increased incidence of postoperative intra-abdominal abscess in cases of complicated appendicitis 3.
Outpatient Laparoscopic Appendectomy
- Outpatient laparoscopic appendectomy can be performed safely in selected patients, with a low rate of postoperative complications and readmissions 4, 5.
- The success rate of outpatient laparoscopic appendectomy is high, with a low morbidity rate and no mortalities or reoperations reported in some studies 5.
- Widespread adoption of outpatient laparoscopic appendectomy has the potential for substantial healthcare savings 5.