Laparoscopic appendectomy. State of the art.

The authors present the results of a fact-finding survey on the state of the art of laparoscopic appendectomy in North-Eastern Italy. Over the period from 1991 to 2000 a total of 10,451 laparoscopic procedures were performed. Despite the extensive and increasing use of minimally invasive surgery, only 58% of the surgeons surveyed adopt laparoscopy in the management of suspected acute appendiceal disease. Thirty-six percent of surgeons indicate laparoscopy for all patients, while 60% reserve laparoscopic appendectomy for female patients. Forty-seven point one percent of procedures are performed in an emergency setting (within 6 hours of admission to hospital). The mean conversion rate is 4.9% and is mainly due to the aftermath of inflammation. Major intraoperative complications are of the order of 0.08%, while major postoperative morbidity is 0.6%. Wound infections are reported in 2% of patients. The mean hospital stay is 3 days. The majority of surgeons remove the appendix even in the absence of macroscopic inflammation and convert the procedure in the presence of suspected neoplastic disease found incidentally at surgery. The high diagnostic potential of the laparoscopic approach may well explain the infrequent use of preoperative imaging techniques.