Recensione a cura di Massimo Sartelli

L’introduzione della chirurgia laparoscopica ha, anche nel caso del trattamento chirurgico dell’appendicite acuta, introdotto la disputa su quale sia il più efficace metodo di approccio a tale patologia. E’ ormai noto come l’approccio laparoscopico rispetto a quello “open” riduca in maniera significativa l’incidenza della infezione della ferita chirurgica, il dolore postoperatorio, la durata della degenza ed il periodo di astensione dal lavoro, ma aumenti, al contrario, l’incidenza degli ascessi intraddominali postoperatori, per la minore capacità insita nell’approccio laparoscopico di garantire una sicura toilette del cavo addominale nelle peritoniti.
In questo studio pubblicato sul British Journal of Surgery del mese di marzo viene confermata l’utilità dell’approccio laparoscopico senza evidenza di complicanze infettive post-operatorie.
Massimo Sartelli

Changing trends in surgery for acute appendicitis.
H. M. Paterson, M. Qadan, S. M. de Luca, S. J. Nixon, S. Paterson-Brown. British Journal of Surgery. Volume 95, Issue 3 , Pages 363 – 368.

Abstract
Background
Laparoscopic appendicectomy (LA) offers faster recovery times and a reduced rate of wound infection compared with open appendicectomy (OA) but may be associated with more intra-abdominal abscesses. This study examines the changing trends in management of appendicitis in a regional setting during service reorganization and compares infective complication rates for each procedure.
Methods
Data were retrieved from the Lothian Surgical Audit database on 1824 patients treated for appendicitis by OA or LA during equal 31-month periods before and after service reorganization in August 2002. Outcome measures were duration of admission, recovery time from operation to discharge and reintervention for infective complications. Analysis was by intention to treat.
Results
The rate of LA in Lothian increased from 29,9 to 39,4 per cent (P < 0,001) after subspecialist service reorganization. Recovery time from operation to discharge was significantly shorter after LA than OA when results were stratified with respect to sex (mean 2,5 versus 4,4 days respectively in women, P < 0,001; 2,7 and 3,1 days in men, P = 0,023), timing of surgery (2,7 versus 3,3 days before subspecialization, P = 0,007; 2,5 versus 3,6 days after subspecialization, P < 0,001) and whether appendicitis was associated with peritoneal contamination (2,2 versus 3,0 days for uncontaminated surgery, P < 0,001; 4,3 versus 5,1 days for contaminated surgery, P = 0,060). Peritoneal contamination at primary operation was the only independent risk factor that predicted reintervention for infective complications.
Conclusion
LA is associated with a shorter hospital stay from operation to discharge than OA, with no evidence of an increased rate of intra-abdominal infective complications.

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