Has Laparoscopic Appendectomy Become the Gold Standard?
DOI:
https://doi.org/10.14748/pbxwvg48Keywords:
acute appendicitis, laparoscopy, appendicular hammerAbstract
Introduction: Appendicitis is one of the most common surgical emergencies. It is traditionally treated by conventional surgery. However, with the advent of minimally invasive surgery, laparoscopic appendectomy is gaining popularity due to faster recovery and less postoperative pain.
Aim: Retrospective study of perioperative data and postoperative results in patients with acute appendicitis operated on at the Clinic of Hepatobiliary, Pancreatic and General Surgery at Acibadem City Clinic Tokuda University Hospital and analysis of the information obtained have been conducted.
Materials and Methods: For the period 01.01.2008–31.12.2024, a total of 1,091 patients with clinical, laboratory and imaging findings of acute appendicitis.
Study Design: single-center, retrospective
Methods:
1/ anamnestic-diagnostic data, including accompanying documentation;
2/ surgical methods—laparotomy and laparoscopy;
3/ follow-up in the early and late postoperative period (patient follow-up in the GammaCode Master hospital system).
Results: The study included 1,091 patients who underwent appendectomy for acute appendicitis. Of these, 653 (59.9%) underwent laparoscopy, 41 underwent laparoscopy followed by conversion (3.8%), and 396 (36.3%) underwent various types of laparotomy. Complications were diagnosed in 21.6% of all patients. The distribution in terms of the stage of inflammation was as follows: catarrhal—13.5%, phlegmonous—46.6%, gangrenous appendicitis—18.5%, gangrenous appendicitis with abscess and perforation—8.9%, chronic and chronic exacerbated—10.9%, and appendiceal tumors (NET, carcinoid, adenocarcinoma, mucinous neoplasm, metastasis)—1.7%. In 473 (43.35%) patients, the appendicular stump was closed using only a tightening Endoloop ligature; an endo-stapler was used in 132 cases or 12.3%.
Conclusions: Since 2017, laparoscopic appendectomy has been the gold standard even in complicated cases of acute appendicitis. In a larger sample of patients, one or two self-tightening ligatures at the base of the appendix are sufficient. Patients who undergo intraoperative conversion are considered a subgroup with an increased risk of morbidity.
References
1. Lawenko MM, Sta Clara EL. Laparoscopic Appendectomy. In: Lomanto D, Chen WTL, Fuentes MB, editors. Mastering Endo-Laparoscopic and Thoracoscopic Surgery. Springer, Singapore; 2023. doi: 10.1007/978-981-19-3755-2_17.
2. Abou-Sheishaa MS, Negm A, Abdelhalim M, et al. Ligation versus clipping of the appendicular stump in laparoscopic appendectomy: a randomized controlled trial. Ann Emerg Surg. 2018;3(1):1029.
3. Minne L, Varner D, Burnell A, et al. Laparoscopic vs open appendectomy. Prospective randomized study of outcomes. Arch Surg, 1997;132(7):708-11. doi: 10.1001/archsurg.1997.01430310022003.
4. Heinzelmann M, Simmen HP, Cummins AS, et al. Is laparoscopic appendectomy the new 'gold standard'? Arch Surg. 1995 Jul;130(7):782-5. doi: 10.1001/archsurg.1995.01430070104022.
5. Rickert A, Bönninghoff R, Post S, et al. Appendix stump closure with titanium clips in laparoscopic appendectomy. Langenbecks Arch Surg. 2012 Feb;397(2):327-31. doi: 10.1007/s00423-011-0869-5.
6. Schildberg C, Weber U, König V, et al. Laparoscopic appendectomy as the gold standard: What role remains for open surgery, conversion, and disease severity? : An analysis of 32,000 cases with appendicitis in Germany. World J Emerg Surg. 2025 Jun 18;20(1):53. doi: 10.1186/s13017-025-00626-2.
7. Thompson L, Cohen BL, Wolde T, et al. Open versus laparoscopic appendectomy: A post hoc analysis of the EAST appendicitis MUSTANG study. Surg Infect (Larchmt). 2023;24(7):613–8. doi: 10.1089/sur.2023.109.
8. Wang CC, Tu CC, Wang PC, et al. Outcome comparison between laparoscopic and open appendectomy: evidence from a nationwide population-based study. PLoS One. 2013;8(7):e68662. doi: 10.1371/journal.pone.0068662.
9. Rogers E. Diffusion of Innovations, 5th Edition. Simon and Schuster; 2003.
10. Wilson CB. Adoption of new surgical technology. BMJ. 2006;332(7533):112–4. doi: 10.1136/bmj.332.7533.112.
11. McCulloch P, Taylor I, Sasako M, et al. Randomised trials in surgery: problems and possible solutions. BMJ. 2002;324(7351):1448–51. doi: 10.1136/bmj.324.7351.1448.
12. Gladwell M. The tipping point: how little things can make a big difference. New York: Little, Brown; 2000.
13. Stöß C, Nitsche U, Neumann PA, et al. Acute appendicitis: trends in surgical Treatment—A Population-Based study of over 800 000 patients. Dtsch Arztebl Int. 2021;118(14):244–9. doi: 10.3238/arztebl.m2021.0118.
