Recommended Incision for Appendicectomy
Laparoscopic appendectomy using the conventional three-port technique is the recommended surgical approach for appendicectomy, which involves three small incisions (10-12mm umbilical port, 5mm suprapubic port, and 5mm left iliac fossa port) rather than a single larger open incision. 1, 2, 3
Primary Surgical Approach
The laparoscopic approach should be chosen over open appendectomy for both adults and children when equipment and expertise are available, as it provides superior outcomes across multiple domains 1, 3:
- Reduced postoperative pain 1, 3
- Lower wound infection rates 1, 2, 3
- Shorter hospital stays 1, 3
- Faster return to work 1
- Improved quality of life 1, 3
The American College of Surgeons and World Journal of Emergency Surgery both recommend laparoscopic appendectomy as the primary approach for acute appendicitis, whether uncomplicated or complicated 1, 3.
Specific Port Placement for Laparoscopic Technique
The conventional three-port laparoscopic technique is recommended with the following configuration 2:
- 10-12mm umbilical port for the laparoscopic camera 2
- 5mm suprapubic port for traction instruments 2
- 5mm left iliac fossa port for dissection and cutting instruments 2
This three-port approach results in shorter operating times, less postoperative pain, and lower wound infection rates compared to open technique 2.
Special Patient Populations
Laparoscopic appendectomy is particularly beneficial for specific patient groups 1:
Alternative Approaches
Single-Incision Laparoscopic Surgery (SILS)
While single-incision laparoscopic appendectomy has been studied, it is not recommended as the primary approach due to significant disadvantages 4, 5:
- Longer operating times (mean difference 5.81 minutes longer) 4
- Higher conversion rates (4.14 times more likely to require conversion) 4
- Comparable complication rates and recovery times to conventional three-port technique 4, 5
- The only advantage is improved cosmesis, which does not outweigh the operational disadvantages 4
Open Appendectomy
Open appendectomy (such as the Lanz incision) should be reserved for 3:
- Resource-limited settings where laparoscopic equipment or expertise is unavailable 3
- Conversion situations when laparoscopic approach cannot be safely completed 3
Important Clinical Caveats
- Surgery should be performed within 24 hours of admission for uncomplicated appendicitis 1, 3
- For complicated appendicitis in children, early appendectomy within 8 hours should be performed 1
- Delaying surgery beyond 24 hours increases the risk of complications and poor outcomes 1
- Even if the appendix appears normal during surgery, it should be removed when no other pathology is found, as macroscopic assessment of early appendicitis is often inaccurate 1