Laparoscopic appendicectomy: pros & cons--literature review of 4190 cases.

The aim of this literature review is to evaluate current data on laparoscopic and open appendicectomy in order to establish a new gold standard in surgery. The authors have reviewed 4190 appendicectomies, 3322 laparoscopic appendicectomies (LA) and 868 open appendicectomies (OA), from 22 studies published between February 1992 and June 1994. Four studies dealt exclusively with pediatric patients (n = 1558). The analysis compares surgical technique, operating time, pathological findings, major and minor complications, postoperative pain and costs. The strongest arguments against LA are the increased rate of major complications, the increase of overall cost and the negative effect of the learning curve. The argument in favour of LA are the significant reduction of minor complications, the shortening of the postoperative hospitalization and of the time to resume full activity. The benefit of LA regarding the amount of analgesia requirement and the time needed to resume normal feeding after surgery is still controversial. The authors have reached the conclusion that LA might emerge as the first choice for appendicectomy. More studies are necessary to confirm this trend.