Laparoscopic appendectomy has been discussed intensely amongst surgeons for many years. In my opinion minimal invasive appendectomy is the operation of choice and the discussion is kept alive by surgeons who have little or no firsthand experience with this technique.



The advantages are clear:


Laparoscopy enables careful inspection of the whole abdomen. Quite often gynecological conditions mimic appendicitis and can only be detected during laparoscopy. Other inflammatory diseases of the bowel can be found as well as a Meckel diverticulum. Surgical removal of the appendix is usually technically easy and even if the inflammation is so massive that it cannot be removed laparoscopically, we know at least exactly where the appendix is located. There is a great variety in localization of the appendix. I remember two recent cases where I found the appendix under the right lobe of the liver, running parallel to the gallbladder. The incision can be made accordingly and kept as small as possible. I have had patients referred to me after appendectomy with scars of 35 cm. Therefore I will always start an appendectomy case with laparoscopy. see figure


The cosmetic aspect of laparoscopy is convincing. Operating time, costs and complication rates compare well. A laparoscopic appendectomy takes 15 -20 minutes. The excellent view enables a very precise and atraumatic preparation and combined with the small incisions results in a very low wound infection rate. Hospital stay is 1-2 days.

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Caution: the following pictures are real surgery pictures.

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The inflamed appendix is dissected with electrocautery.