In the right lower part of the abdomen there is a small blind ending intestinal tube, called appendix. Inflammation of the appendix is called appendicitis and is usually acute in onset. Appendicitis is most frequent in children and young adults. Most cases require emergency surgery, in order to avoid rupture of the appendix into the abdomen. During the operation, called appendectomy, the inflamed appendix is surgically removed. The traditional surgical approach involves a small incision (about 5 cm or 2 inches) in the right lower abdominal wall. Alternatively, it is possible to perform the operation by laparoscopy. This operation, called laparoscopic appendectomy, requires 3 very small incisions (each about 1 cm or 1/2 inch). The surgeon then introduces a camera and some instruments into the abdomen and removes the appendix as in the conventional operation.
This review analysed 67 clinical studies, in which surgical technique (conventional open or laparoscopic) for each patient was determined by chance. The majority of studies were done on adults, but there were also 7 studies on children. The main advantages of laparoscopic over conventional appendectomy were reduced risk of wound infection, reduced postoperative pain, shorter hospital stay (-1 day), and more rapid return to normal activities. As disadvantages of laparoscopic appendectomy a longer duration of the operation (+10 minutes) and a higher rate of intraabdominal abscesses were identified. The results for children were similar to those seen in adults. An additional benefit of the laparoscopic approach is the possibility to inspect the inside of the abdomen. Especially in women of childbearing age, in whom many other conditions can mimic appendicitis, laparoscopy therefore reduces the risk of an unnecessary appendectomy.
In summary, laparoscopic surgery for suspected appendicitis has diagnostic and therapeutic advantages as compared to conventional surgery. However, conventional appendectomy should not be considered 'wrong', because the difference between the two techniques is rather small and strongly depends on patient characteristics and the treating surgeon's expertise.