The surgical management of appendicitis

Appendicitis remains one of the most common surgical emergencies, with approximately 200,000 annual cases in the United States and a lifetime risk of 8%. [1] The treatment of appendicitis has evolved significantly, from the first reported appendectomy in 1736 at St. George's Hospital in London. [2] The surgical treatment of appendicitis has gone through numerous permutations. This chapter discusses the history and current surgical therapies for appendicitis, with a critical review of the literature. The open appendectomy, initially described by Charles McBurney in 1894, is classically done through an oblique, muscle-splitting incision in the right lower quadrant. [3] Until the advent of the laparoscopic appendectomy in 1982, the open appendectomy was considered gold standard for treatment. [4] Over the past 20 years, laparoscopic appendectomy has largely replaced open appendectomy. This procedure is typically performed using three ports, and allows for thorough inspection of the peritoneal cavity, wide irrigation, and safe removal the appendix. [5] The ability to examine adjacent organs and evaluate for alternative pathology is particularly beneficial when faced with a normal appearing appendix in a young female patient. A recent Cochrane review comparing open versus laparoscopic appendectomy demonstrated that laparoscopy conferred significant benefit with regard to wound infection and post-operative pain. The magnitude of benefit is rather modest, however, and open appendectomy remains a viable option. Further advances in the surgical management of appendicitis have focused on minimizing trocar size and number, which may decrease pain and improve cosmesis. [6] Towards this end, single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have been applied to appendectomy. [7-10].