Dr Frazee and his colleagues deserve our thanks for their continuing effort to remove the voodoo-like mysticism surrounding the employment of the minimally invasive approach for the treatment of acute appendicitis. Resistance to the use of this approach in this country is very puzzling. This is especially true when you consider the high perforation rate in the very young and elderly, the frequent dilemma of diagnosis in the female population, and the larger incision required for the obese patient. Finally, there is a definite advantage to being able to return to aggressive physical activity sooner.
While I applaud their demonstration of the efficient interventional capability of the minimally invasive technique in complicated acute appendicitis, I disagree with their conclusions. The basis of this opposition lies within the confines of the current textbooks of surgery. The morbidity rate associated with perforated appendicitis is 30% to 60%. The wound infection rate is