Laparoscopic vs. open Appendectomy Systematic review of medical efficacy and health economic analysis

  • Dintsios CM Schönermark Gorenoi V
  • Published 2011

Abstract

Appendicitis is an inflammation of the appendix of the blind intestine. Appendicitis in the developed countries is by far the most frequent cause for an acute abdomen. The risk to fall ill with appendicitis in the course of life lies in a range of approximately 7 to 9 %. Appendicitis occurs in all age-groups, most frequently in children, adolescents and young adults between four and 25 years (age peak: ten to 19 years). Young boys and men fall ill more frequently than girls and young women. If there is a suspicion of appendicitis, an operation, called appendectomy, is indicated. This procedure should be conducted as early as possible (within approximately 48 hours). Both, an open surgical intervention as well as a laparoscopic intervention are used for the excision of the inflamed appendix. The open appendectomy is considered to be the gold standard in the treatment of the appendicitis. The appendix is usually dissected and removed through opening of the abdominal cave by cut on the right side of the abdomen under the umbilical line. The junction to the blind intestine will be sutured, the epidermis will be either sewed or stapled. The appendix can be alternatively removed by a laparoscopic approach. In this intervention, the abdominal cave is not opened. An optic system and instruments are introduced through three small incisions in the abdominal wall. The surgeon performs the excision of the inflamed appendix, watching the surgical site on a monitor. The excision of the appendix follows the same principle as the open abdominal operation but the inflamed tissue is removed from the abdominal cave through the trocar. The laparoscopic operation avoids the long cut through the skin and the layers of the abdominal wall (cosmetic effect) and can therefore diminish the postoperative pain and wound complications. As an exploratory procedure, checking out unspecific lower abdominal pain, it allows both diagnostic and simultaneous surgical treatment. A shorter average length of hospital stay as well as an earlier return to normal everyday life activity are expected as sequelae of laparascopic appendectomy. On the other hand the risk of intraabdominal abscesses by the laparoscopic procedure is suspected to be increased. The experience of the operator is also important since the handling of the longer instruments and the twodimensional vision of the operation field in the laparoscopic appendectomy are unusual for the surgeon. The laparoscopic appendectomy seems also to be more cost-intensive if one considers the costlier devices and probably slower procedure. DAHTA@DIMDI Waisenhausgasse 36-38a D-50676 Köln

Cite this paper

@inproceedings{V2011LaparoscopicVO, title={Laparoscopic vs. open Appendectomy Systematic review of medical efficacy and health economic analysis}, author={Dintsios CM Sch{\"{o}nermark Gorenoi V}, year={2011} }