Over the last 20 years, the treatment of acute
appendicitis has been transformed by the development of the laparoscopic approach. And yet the net value of this approach continues to be debated. Laparoscopic
appendectomy is associated with a lower complication rate and a shorter period of disability in the general population. While operative costs are higher, the global cost of laparoscopic
appendectomy is lower than for open
appendectomy. There is a somewhat higher rate of
abdominal abscess for the laparoscopic route. Laparoscopic
appendectomy shows clear advantages in obese patients and in those with gangrenous or
ruptured appendicitis. The laparoscopic approach is contra-indicated during pregnancy due to a higher incidence of
miscarriage. Treatment of the appendiceal stump by
ligature decreases the expense associated with the use of a
surgical stapler. When
Meckel's diverticulum is encountered during
appendectomy, it should be removed in all pediatric patients; in adults, Meckel's diverticulectomy in adults should be performed only for clear-cut pathology. Surgeons continue to innovate and refine
appendectomy techniques but many questions remain to be answered.