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Invited Commentary

Brian C. Organ, MD
Arch Surg. 1995;130(7):785. doi:10.1001/archsurg.1995.01430070107023.
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Heinzelmann and coworkers present further data for the continuing controversy with respect to open vs closed laparoscopic treatment of patients with acute appendicitis. Despite numerous flaws in the methodology of this study and broad sweeping conclusions based on a paucity of data, it is a question worth discussing.

Numerous studies throughout the literature have verified that laparoscopic appendectomy offers increased safety, shorter hospital stay, less pain, and quicker return to work. Additional potential benefits include detection of pathologic condition when the diagnosis is not certain, shorter postoperative ileus, quicker return of gastrointestinal function and resumption of normal diet, fewer postoperative wound infections (because the infected appendix is removed through a trocar and does not contaminate the wound), better visualization and greater ease of suction and irrigation of the pelvis, and a reduction in the rate of unnecessary appendectomies, particularly in young women.

Justifiable criticism of the laparoscopic method centers around


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