Appendicitis surgery – keyhole or open?

In the keyhole procedure known as a “laparoscopy,” three small cuts are generally made in the skin and wall of the belly. The surgeon feeds a camera and the surgical instruments into the abdominal cavity (space in the belly) through thin tubes. They can then clearly see the appendix and the nearby organs on a monitor. They separate the appendix from the cecum (the pouch at the beginning of the large intestine) and remove it from the abdominal cavity through one of the tubes. A general anesthetic is used for this procedure.

In open surgery, the surgeon makes a cut (about 5 centimeters long) in the lower right part of the abdomen so that they can clearly see the area around the appendix from outside. The appendix is then cut off and removed. After that, the belly is sewn back together. This procedure is also done under general anesthesia.

As with any surgical procedure, these approaches are associated with certain risks. These include wound infection, bleeding after surgery and injury to the bowel or other organs. In veryx rare cases, the tissue does not heal well and growths known as “adhesions” develop, which may cause abdominal pain and even life-threatening obstruction (blockage) of the bowel.

In keyhole surgery, only small cuts have to be made in the skin, so no bigger scars are left on the lower abdomen. This minimally invasive procedure is generally considered to be gentler. Researchers from the Cochrane Collaboration (an international research network) have looked into this. They compared keyhole surgery with open surgery. They analyzed several studies where adults or children with appendicitis were treated with these procedures. But the studies were carried out in different ways, and not all of them were of good quality.

Overall, the researchers came to the conclusion that many (but not all) aspects of keyhole surgery were better than open surgery.

The adults and teenagers who had keyhole surgery in the studies were free of pain sooner after the operation. The length of time people had to stay in hospital, and how long it took them to return to their usual daily activities, varied a lot in both groups. But it can be said that the people who had keyhole surgery had to stay in hospital for one day less on average and could carry out their daily activities around five days sooner than those people who had open surgery.

Wound infections were less common after keyhole surgery than after open surgery:

• 30 out of 1,000 adults and teenagers who had keyhole surgery had a wound infection, compared to
• 68 out of 1,000 people who had open surgery.

But open surgery was found to have a slight advantage regarding another complication. Abscesses (pockets of pus) in the abdominal cavity were less common after open surgery than after keyhole surgery:

• 12 out of 1,000 adults and teenagers who had open surgery developed an abscess in the abdominal cavity, compared to
• 20 out of 1,000 people who had keyhole surgery.

Other research groups reached similar conclusions.

The Cochrane group’s research found that keyhole surgery also prevented wound infections in children:

• 11 out of 1,000 children who had keyhole surgery had a wound infection, compared to
• 42 out of 1,000 children who had open surgery.

Unlike with adults and teenagers, abdominal cavity abscesses were also less common in children after keyhole surgery. The studies comparing the procedures in children were less reliable, though.