Conventional vs. Laparoscopic Appendectomy in Emergency Patients. Is There a Better Approach

Introduction: Surgical treatment of acute appendicitis is relatively easy with a minimally invasive approach. Laparoscopy produces a very good image; applies less trauma, has better cosmetics and patients recover more quickly. However, its routine use requires prepared laparoscopic sets, trained personnel and specific organization. The main difficulties of both methods are associated with atypical anatomical locations and complicated forms of the disease.Aim: The objective of the study is to compare the reasons influencing the decision to choose a laparoscopic or a conventional approach for appendectomy. Surgeries performed in the span of four years in II-nd Surgery, Hospital Alexandrovska (2012-2016) were evaluated.Materials and Methods: The study covered 67 patients with acute appendicitis. Of those 8 (11.9%) were operated on with a laparoscopic approach . The average age was 27.4 years. There were 23 men (34.3%) and 44 women (65.7%). The average conventional intervention duration was 70 minutes, while in the laparoscopic procedure it was 55 minutes (P <0.05). Eight different surgeons were part of the process and they influenced the decision for a minimally invasive approach. The mean age of the surgeons who carried out the laparoscopic interventions was under 40 years and for conventional approach was over fifty. Results: Catarrhal inflammation of the appendix was found in 31 of the implemented interventions (46.3%) and the remaining 36 were destructive forms (53.7%). There were three phlegmonas (37.5%) and five catarrhs (62.5%) in the laparoscopic cases. Of them 3 were performed through an umbilical single port. The reported average postoperative stay was 3.4 days for the conventional group and 2.2 days (P = 0.07) for the other group.Conclusion: Training and operating room resource availability predetermine the increasing use of the minimally invasive approach when treating acute appendicitis.