updated 12/22/2003 2:12:02 PM ET 2003-12-22T19:12:02

When an appendix needs to be removed, patients who have minimally invasive surgery fare far better than those who have traditional operations, a review of several studies indicates.

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Patients who had laparoscopic appendectomies had fewer complications, left the hospital faster and went back to work sooner, two Duke University researchers found after reviewing results of studies involving 43,000 patients.

The analysis is not definitive, the doctors said. “But we have seen definite advantages to laparoscopies,” said Dr. Ricardo Pietrobon, who did the analysis with Dr. Ulrich Guller. Their findings are being published in the January edition of Annals of Surgery.

In laparoscopy, surgeons make short incisions, about a quarter-centimeter in length, then insert a tiny camera to guide them as they use cutters, staplers and a tiny sterile bag to remove the appendix.

That compares to the traditional procedure, in which a surgeon cuts a five- to six-centimeter slit in the lower right section of the abdomen. Despite stringent sterilization, the wound can become infected while the organ is removed.

Cuts down on infection
Dr. Craig Fischer, assistant professor of surgery at the University of Texas Medical School at Houston, said he uses laparoscopy about 90 percent of the time for appendectomies.

“You put the appendix inside this tiny sterile bag, tie the bag’s string so the appendix doesn’t drip into the abdomen, and pull it through,” Fischer said. “The appendix is squishy, so it’ll go through a smaller hole, and the bag cuts down on infection significantly.”

Doctors say the bag doesn’t work in a traditional procedure, possibly because the incisions create a bigger pool in which the bacteria can swim. In laparoscopy, the appendix doesn’t move until it’s time to remove it, Fischer said.

A higher rate of infection from open surgery may be why the Duke study shows patients who undergo traditional appendectomies stay in the hospital approximately three days, versus two days for laparoscopies.

The function of the appendix — an organ near the right hip that looks like a tube the size of a fat ball point pen — remains a mystery to biologists.

If it gets infected and ruptures, spilling the same sort of fecal bacteria that fills the colon into the abdominal cavity and the bloodstream, it can be deadly.

Fischer said he draws the line at using laparoscopy to remove an appendix that he believes has already burst, because it takes too long. But the authors of the Duke study said they found no significant differences in postoperative complications in such cases.

Although nearly every hospital in the country offers both procedures, some doctors still resist laparoscopies, which have only been common since the early 1990s.

One reason may be cost. But Guller and Pietrobon say that less follow-up care and fewer post-operation sick days could balance out the expense.

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