Friday, May 18, 2007
Is there anyone out there who preferentially performs open appendectomies rather than laparoscopic? I know, there's that prospective randomized trial from Archives of surgery (1997) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=9230853 that showed no benefit to laparoscopic versus open techniques. Moreover, it determined that OR time was longer and expenses higher with the laparoscopic approach. But let's be honest. 1997 was ten years ago. This was data accumulated by surgeons who were just getting comfortable with the technique. As a recent graduate of residency, I learned from talented laparoscopic surgeons, rather than making things up on the fly. People who regularly do laparoscopic appendectomies I think will concur that it's actually faster than an open approach. Pain usually is less. And, most important, the wound complication rate is negligible. The port sites simply don't get infected, but in rare cases, even in situations of advanced, perforated appendecitis. Abscess and fluid collections, even when located down in the pelvis, are easily irrigated and aspirated laparoscopically. Long term, fewer adhesions and a lower incidence of abdominal wall hernia would seem axiomatic. I don't get why people are electing to do these cases with open McBurney's incisions anymore. Similar to the holdovers who persisted in doing open cholecystectomies (albeit, with the so-called mini-incision) into the early nineties, I think if you're not doing laparoscopic appendectomies, you risk becoming a dinosaur much like them.