Appendectomy: laparoscopy is not always the best option

I had my appendix taken out laparoscopically in 1998. What was expected to be a simple operation caused me a lot of pain that persisted for a long, long time. Four years later, I had my thyroids taken and shared a room with a lady who, too, had laparoscopic appendectomy and had similar problems as I did.

The laparoscopic surgical technique became popular in the 1990s and is now the “gold standard” for simple procedures inside the body cavity such appendectomy. Here is how it works:

The abdomen in inflated with air, and a very small camera is inserted through a tiny incision. This enables the surgeon to control the tiny surgical instruments also inserted through tiny holes in the body cavity.

Compared to open surgery, laparoscopy is minimally invasive, causes less scarring and minimizes the risk of infection since the body cavity is less exposed to the air. The surgical wound heals fast and the patient is up and running in no time.

However, researchers at the University of Rochester Medical Center (URMC) report that there are some patients wherein laparoscopy may actually not be the best option.

According to study author Dr. John Monson, head of the Division of Colorectal Surgery at URMC.

“Our study corroborates a common theme in medicine: one size does not fit all. While the data suggest that the laparoscopic approach is still best for most patients, it might not be best for all.”

A small number of laparoscopic patients suffer from what is called “deep infection” inside the body cavity and these patients take months to heal and get back on feet, incurring tremendous costs.

Monson continues to explain:

“We think it comes down to balance. It’s not just about how much a procedure exposes the body to potential infection – it’s also about how easily that procedure allows you to mitigate infection risk… Consider the open approach. Admittedly there’s more chance of exposure to microbes – the wound is wide open. But there’s also more opportunity to sterilize, since you can meticulously clean the operating space before closing it. [In laparoscopy], there’s less exposure to the outside environment, but there’s also less opportunity to disinfect the organ space.”

The researchers tried to identify the risk factors that make some patients suitable or unsuitable for having a laparoscopic procedure. They report that patients with a certain profile are more likely to suffer from deep infection than others. These “high-risk patients” are

• Male
• Of older age
• Smoker
• Diabetic

In this day and age of “personalized” medicine, doctors are advised to assessment their patients for suitability and risks for this seemingly simple procedure.
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