Appendicectomy by laparoscopy: is it justified?

Laparoscopic appendicectomy (LA), in contrast to open appendicectomy (OA), is not generally accepted as the treatment of choice for suspected appendic itis because it is technically difficult, not readily available everywhere, takes longer to perform, is expensive, and is associated with an increased incidence of intra-abdominal abscesses. However, LA has shown a superior o utcome compared to an OA in terms of less postoperative pain, earlier hospi tal discharge, quicker return to normal activity and work and decreased inc idence of wound infection. Furthermore, a diagnostic laparoscopy is valuabl e in case of an equivocal diagnosis of appendicitis especially in premenopa usal women and obese individuals because it allows a thorough examination o f the whole abdomen under direct vision. It, therefore, permits accurate di agnosis and hence reduces the negative appendectomy rate. Nevertheless, bef ore endorsing routine and widespread use of LA, it is essential that this t echnique is critically evaluated in well designed, controlled, randomised, prospective trials clearly showing major benefits to the patient in terms o f quicker hospital discharge, reduced postoperative pain, decreased wound i nfection and early return to full activities.