Has the time come to generalise the laparoscopic approach for complicated acute appendicitis in real scenarios? A prospective randomized study

Giuseppe Carollo, Alessandro Corigliano, Roberto Gullo, Claudia Carolla, Paola Mercurio, Leonel Kamdem, Marco Dominici, Irene Vitale, Selene Luddeni, Giuseppina Orlando

Unit of General and Emergency Surgery, Department of General, Emergency and Transplant Surgery, Policlinico “P. Giaccone”, University of Palermo, Via L. Giuffré 5, 90100 Palermo, Italy

Introduction: Acute appendicitis is one of the most frequently observed surgical emergencies in general surgery units. The laparoscopic approach (LA) is now widely accepted, but it is still unclear whether it can be proposed as a generalizable option to the whole team. The purpose of this prospective randomized study is to evaluate whether LA produces benefits for different skill classes of the operating surgeon.

Materials and methods: In the present study, 118 patients were recruited, 59 operated with conventional technique (CA) and 58 with LA. Age, gender, ASA score, severity of appendicitis surgeon's skill  were recorded and procedure duration, conversion rate, post-operative pain, day of discharge and complications were evaluated.

Results: Patients that underwent LA had more favorable or no inferior outcomes than the CA group, regardless of the skill class of the surgeon. In particular, the two groups showed very similar operation duration and better postoperative recovery.

Conclusion: On the light of the results LA can therefore be adopted as the technique of choice in a general surgery unit.