Appendicitis: When do we operate laparoscopically and when conventionally?

Based on the East German Multicenter study, our investigation was aimed to evaluate the role of laparoscopy for treatment of appendicitis. A prospective multicentric trial including 4,846 appendectomies was performed at 34 hospitals from June 1, 1996 to May 31, 1997. There were 3,237 primary open appendectomies (66.8%), and 1,609 appendectomies (33.2%) were started laparoscopically. A conversion to the open procedure was necessary in 116 cases (conversion rate 7.2%). The highest morbidity was found in case of conversion (22.4%). in case of nonperforated appendicitis the complication rates of open and laparoscopic appendectomy were similar. If perforated appendicitis had been treated laparoscopically, an increased rate of intraabdominal abscesses (9.1%) was found. The laparoscopic procedure is safe in case of non-perforated appendicitis and in experienced hands. Open appendectomy remains the standard treatment in ail cases with clear diagnosis of acute appendicitis.