A decade of laparoscopic appendectomy: presentation of 1,026 patients with suspected appendicitis treated in a single surgical department.

BACKGROUND

The laparoscopic approach for suspected appendicitis is increasingly gaining acceptance. Nevertheless, the discussion on its safety, efficacy, indications, and diagnostic accuracy remains open.

METHODS

During the decade 1993-2003, 1026 patients with suspected appendicitis were approached by laparoscopy. Sixty-three patients (6.1%) had chronic recurrent symptoms. Data were collected retrospectively and analyzed. There were 587 female and 439 male patients. Fertile women were compared to all other patients with respect to the diagnostic accuracy of laparoscopy.

RESULTS

Conversion rate was 0.55%. Median operating time was 26 minutes. Overall complication rate was 5.7%, consisting mostly of minor complications. There were no major intraoperative complications. Wound infections and intra-abdominal abscesses were reviewed separately and were 1.1% and 0%, respectively. Diagnosis could be established via laparoscopy in 89% of all patients, 85.4% of fertile women, and 93.1% of patients except fertile women. A median of 4 minor analgesics and 2 narcotics were required after surgery. The median time until bowel movements, intake of solid food, and the median length of hospital stay were 24, 48, and 30 hours, respectively. Patients returned to normal activity after a median of 7 days. There was no mortality. There was 1 reoperation. Follow-up lasted 4 weeks.

CONCLUSION

Laparoscopic appendectomy is a well-justified procedure in the treatment of acute and chronic appendicitis. If there is enough experience, patients can profit from a higher diagnostic accuracy, quicker return of bowel habits, less postoperative pain, shorter hospital stay, and a faster return to normal activities than is reported for the open procedure. Especially, fertile women can profit from these advantages. This abstract has been presented as a poster in the SAGES Conference 2004.