Abstract
Background: The value of laparoscopic appendectomy remains controversial. Therefore, we investigated the accuracy of diagnostic laparoscopy in detecting acute appendicitis and tested the applicability and safety of stapling appendectomy as a routine procedure.
Methods: Data from 267 consecutive patients with suspicion of acute appendicitis were recorded prospectively.
Results: Histopathological examination revealed nonperforated and perforated appendicitis in 63.3% and 13.1%, respectively, and no inflammation in 10.8%. Other pathological findings were observed in 12.7%. Diagnostic laparoscopy detected appendicitis with a sensitivity and specificity of 95.6% and 96.6%, respectively; the positive and negative predictive value were 99.5% and 74.3%, respectively. Morbidity was 10.2% in total and 40% for perforated appendicitis. Planned laparoscopic reexploration reduced morbidity by 23.4% in patients with perforated appendicitis and substantial peritonitis. Mortality was 0.4%.
Conclusions: Laparoscopy improves diagnostic accuracy for acute appendicitis and laparoscopic stapling appendectomy is a safe and efficient procedure for all forms of appendicitis.
Similar content being viewed by others
References
Berry JJ, Malt RA (1984) Appendicitis near its centenary. Ann Surg 200: 567–575
Dueholm S, Bagi P, Bud M (1990) Laboratory aid in the diagnosis of acute appendicitis. A blinded, prospective trial concerning diagnostic value of leukocyte count, neutrophil differential count, and C-reactive protein. Am J Physiol Imaging 5: 89–96
Fisher KS, Ross DS (1990) Guidelines for therapeutic decision in incidental appendectomy. Surg Gynecol Obstet 171: 95–98
Götz F, Pier A, Bacher C (1990) Modified laparoscopic appendectomy in surgery. Surg Endosc 4: 6–9
John H, Neff U, Kelemen M (1993) Appendicitis diagnosis today: clinical and ultrasonic deductions. World J Surg 17: 243–249
Klaiber C, Metzger A (1995) Manual of laparoscopic surgery, 2nd ed. Hans Huber, Bern
Klaiber C, Wagner M, Metzger A (1994) Various stapling techniques in laparoscopic appendectomy: 40 consecutive cases. Surg Laparosc Endosc 4: 205–209
Klaiber CM, Leepin A, Saager H Ch (1991) Die laparoskopische Cholezystektomie: 100 konsekutive Faelle ohne postoperative Morbiditaet. Schweiz Med Wochenschr 121: 898–902
Krukowski ZH, Denholm S, Matheson NA (1988) Preventing wound infection after appendicectomy. Br J Surg 75: 1023–1033
Kum CK, Ngoi SS, Goh PMY, Tekant Y, Isaac JR (1993) Randomized controlled trial comparing laparoscopic and open appendicectomy. Br J Surg 80: 1599–1600
Lau WY, Fan ST, Yiu TF, Chu KW, Suen HC, Wong KK (1986) The clinical significance of routine histopathologic study of the resected appendix and safety of appendiceal inversion. Surg Gynecol Obstet 162: 256–258
McAnena OJ, Austin O, O'Connell PR, Hederman WP, Gorey TF, Fitzpatrick J (1992) Laparoscopic versus open appendicectomy: a prospective evaluation. Br J Surg 79: 818–820
Navez B, D'Udekem Y, Cambier E, Richir C, Guiot P (1994) Value of celioscopy in non-traumatic acute abdomen. Ann Chir 48: 625–631
Nguyen BL, Raynor S, Thompson JS (1992) Selective versus routine antibiotic use in acute appendicitis. Am Surg 58: 280–283
Olsen JB, Myren CJ, Haahr PE (1993) Randomized study of the value of laparoscopy before appendicectomy. Br J Surg 80: 922–923
Plane P, Créange JP, Ronceray J, Mahoue J (1978) Etude statistique homogène portant sur 1,643 cas d'appendicectomies. J Chir (Paris) 115: 523–532
Reiertsen O, Trondsen E, Bakka A, Andersen OK, Larsen S, Rosseland AR (1994) Prospective nonrandomized study of conventional versus laparoscopic appendectomy. World J Surg 18: 411–415
Silberman VA (1981) Appendectomy in a large metropolitan hospital. Retrospective analysis of 1,013 cases. Am J Surg 142: 615–618
Troidl H, Gaitzsch A, Winkler WA, Muller W (1993) Errors and danger in laparoscopic appendectomy. Chirurg 64: 212–220
Wittmann DH, Aprahamian C, Bergstein JM (1990) Etappenlavage: advanced diffuse peritonitis managed by planned multiple laparotomies utilizing zippers, slide fastener, and Velcro analogue for temporary abdominal closure. World J Surg 14: 218–226
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Wagner, M., Aronsky, D., Tschudi, J. et al. Laparoscopic stapler appendectomy. Surg Endosc 10, 895–899 (1996). https://doi.org/10.1007/BF00188478
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00188478