A Critical Analysis of Laparoscopic Appendectomy: How Experience with 1,400 Appendectomies Allowed Innovative Treatment to Become Standard in a University Hospital

Background Although advantages of laparoscopic appendectomy (LA) have not yet been proved, there is increasing evidence that LA provides diagnostic and therapeutic advantages as compared to conventional surgery. This article reports the introduction of LA in a university hospital where LA now repres...

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Veröffentlicht in:World journal of surgery 2008-07, Vol.32 (7), p.1406-1413
Hauptverfasser: Schick, Kerstin S., Hüttl, Thomas P., Fertmann, Jan M., Hornung, Hans-Martin, Jauch, Karl-Walter, Hoffmann, Johannes N.
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Sprache:eng
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Zusammenfassung:Background Although advantages of laparoscopic appendectomy (LA) have not yet been proved, there is increasing evidence that LA provides diagnostic and therapeutic advantages as compared to conventional surgery. This article reports the introduction of LA in a university hospital where LA now represents the standard operative procedure in patients with suspected appendicitis. Methods Consecutive patients with appendectomy were prospectively included in the surgical database from 5/1991 to 10/2005. Operating time skin-to-skin in minutes, conversion from laparoscopy to open appendectomy, and complications requiring reoperation as well as surgical expertise were recorded. Results After initial performance of LA by four experienced specialists in laparoscopic surgery between 1991 and 1994, LA was routinely implemented from 1995 to 2005. Laparoscopic appendectomy was performed in 1,012 patients, and conventional appendectomy in 449 patients, with a LA rate of about 90% in recent years. Intraoperative conversion was deemed necessary in 62 patients (6.2 %) by 40 surgeons among the 103 surgeons who performed LA over 14 years with a mean operative time of 57 ± 2 min. Between 1995 and 2005 about 25%–30% of LAs were performed as the first LA for the respective surgeon. Laparoscopic appendectomy was associated overall with a reduced length of stay in the hospital compared to open appendectomy (LA: 4.4 ± 0.1 days versus 6.6 ± 0.2 in open appendectomy; p  
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-007-9429-0