Appendicectomy for simple appendicitis: video-assisted or intracorporeal?

ABSTRACT

BACKGROUND: We reviewed our experience with laparoscopic appendicectomy (LA) to compare the video-assisted and intracorporeal approaches. MATERIALS AND METHODS: One hundred and sixty-one (161) patients undergoing LA for simple appendicitis were considered. The procedure was video-assisted with an extracorporeal appendicectomy in 74 cases operated on during the first 5 years of our experience (group A), whereas it was entirely intracorporeal in the subsequent 87 (group B). In the latter group, the dissection of the mesoappendix was accomplished by using titanium clips in 38 cases, with monopolar coagulation in 42 and other devices in 7. The base of the appendix was closed by using endoloops in 11 patients and a stapler in 76. In all the intracorporeal LAs, the appendix was delivered through a port site. A very low position of the two accessory ports was adopted in 34 group B patients. RESULTS: No difference in outcome was found between the two groups, except in operating time (48 vs. 29 minutes) and length of hospital stay (3 vs. 1 day). The complication rate was not statistically different among the various techniques used in group B to divide the mesoappendix and to close the base of the appendix. The cost of disposable instruments for intracorporeal LA was 3- to 6 folds higher than for the extracorporeal one. An extremely low position of the ports did not interfere with the procedure in any case. CONCLUSIONS: LA for simple appendicitis can be performed safely with many techniques. The intracorporeal procedure allows for a shorter operating time, but can dramatically increase the costs of the disposable instruments that are required.