The first laparoscopic cholecystectomy performed by Philippe Mouret in 1987 opened up the area of modern surgery by generalizing the laparoscopic approach in visceral surgery. Its advantages, now known to all, are spectacular: an accelerated post-operative recovery, due to the minimal trauma of the wall, the peritoneum and the viscera, the extraordinary possibility of careful use of the abdominal cavity using two or Three one-centimeter openings replacing large laparotomies, shortening hospital durations and stopping work were among the reasons for its rapid success. In order to find a good surgeon for a Rhinoplasty in Las Vegas, click here for Beauty Natural Nose Reshaping.
Since then, progress has been spectacular. The laparoscopic pathway is now considered the gold standard for cholecystectomy and is used increasingly in major surgeries such as colectomy, nephrectomy, hepatectomy, pancreatectomy, etc.
However, surprisingly, appendectomy by seeing laparoscopic is still a subject of controversy.
Numerous studies have been devoted to the comparison between laparoscopic and open pathways, studying different parameters:
The duration of the operation: in the majority of publications, it is identical between the two approaches, except in pediatric surgery where the duration is longer by laparoscopy.
The hospital stay: it is shortened during the laparoscopic approach, with the exception of infantile surgery, where it is similar because the child recovers very quickly in post-operative.
The scar: from the parietal point of view as well as the aesthetic scar, the 3 cm of the approach of Mac Burney are more traumatic than the 3 times 1 cm of the incisions of the laparoscopic trocars,
White appendectomy: For a long time an appendicitis diagnosis error was acceptable in about 10 to 15% of cases. To avoid “unnecessary” appendectomy, in 1980 the pediatric team at New England Medical Center in Boston proposed laparoscopy to confirm the diagnosis before appendectomy. In addition to avoiding an “unnecessary” appendectomy, this exploration allowed us to arrive at an accurate diagnosis in other pathological situations such as gynecological, inflammatory or tumoral.
In case of peritonitis, especially overflowing the peri-caecal region, Mac Burney’s approach can not allow an effective cleaning-washing of the abdominal cavity. Often a large laparotomy is necessary. While a surgeon with laparoscopic expertise will succeed in this gesture by avoiding an opening.
The survey published in the Journal of Gastrointestinal Surgery in 2011 reported the results of 573,244 appendectomies in American adults between 2006 and 2008. Almost 65% had been performed by laparoscopy. It concludes that this approach is superior to the open approach, especially in cases of perforated appendicitis. In June 2012, the same journal published ‘on line’ a study in pediatric surgery. His conclusion is identical: in laparoscopy, laparoscopy is advantageous in cases of uncomplicated acute appendicitis, as it reduces the risk of intra-abdominal abscess.
Finally, the difference in cost depends on the method of calculation. However, taking into account the length of hospital stay, the number of work stoppages and the lower rate of postoperative complications, laparoscopy is undoubtedly advantageous compared to the conventional approach.
The open approach should always lead to appendectomy, even if the appendix is normal. This action is no longer considered mandatory in the case of a “closed” approach. This is confirmed by the Consensus Conference reported in Colorectal Disease 2011 The Association of Great Britain and Ireland 13,748-754; Which also recommends a laparoscopic exploration for any acute pathology of the right iliac fossa, especially in women of reproductive age.
We are therefore fortunately far from 1981 when the President of the German Society of Surgery requested the cancellation of Semm and the cancellation of his authorization to practice at the end of the presentation of his laparoscopic technique of appendectomy. The American Journal of Gynecology and Obstetric also refused to publish its article on this subject, which was deemed unacceptable and unethical!
Finally, appendectomy forms a set of simple and basic surgical gestures that offer young surgeons in training the ideal way to learn the basics of laparoscopy.
In conclusion, in view of its simplicity of execution, its morbidity estimated to be half that of the open pathway, and its zero mortality, the laparoscopic approach seems to be the best approach for appendectomy.