Laparoscopic Assisted or Total Laparoscopic Appendectomy
Laparoscopic Assisted or Total Laparoscopic Appendectomy
Acute appendicitis (AA), is a common intra-abdominal surgical pathology with the overall
 incidence of approximately 7% and mortality of 0.2-0.8%. Treatment of choice is the surgical
 removal of the inflamed appendix by using open or laparoscopic appendectomy.

 Following laparoscopic appendectomy (LA) proved to be a feasible and at least as safe as the
 corresponding open procedure, it has rapidly gained worldwide acceptance. The traditional
 approach to LA uses three ports. Over the past decade, successful attempts to perform the
 procedure with fewer ports have been reported.

 The authors' primary objectives were to 1) identify a simple, safe and feasible way to
 perform laparoscopic appendectomy in patients with uncomplicated acute appendicitis. 2)
 determine the health related quality of life of the patients and calculate the cost per
 quality adjusted life years (QALYs) gained after the procedures (LAA and TLA). 3) Purpose a
 surgical algorithm when approaching to acute appendicitis with the consideration of quality
 of health and cost.
Acute appendicitis (AA), is a common intra-abdominal surgical pathology with the overall
 incidence of approximately 7% and mortality of 0.2-0.8%. Treatment of choice is the surgical
 removal of the inflamed appendix by using open or laparoscopic appendectomy. Until the first
 laparoscopic removal of an inflamed appendix by Kurt Semm in 1980, the gold standard for
 surgical treatment of acute appendicitis remained open appendectomy as first described by
 McBurney in 1891.

 At the beginning, LA remained questionable whether the benefits of the procedure outweigh
 over its disadvantages. However, since laparoscopic technology advances and surgeons'
 expertise increases, many surgeons have successfully performed a multitude of laparoscopic
 procedures for AA, with a continued increasing trend in its use. Eventually, after LA proved
 to be a feasible and at least as safe as the corresponding open procedure, it has rapidly
 gained worldwide acceptance.

 There are more techniques for LA in the literature but only a few of them have gained to
 access and described in modern textbooks. The traditional approach to LA uses three ports.
 Over the past decade, successful attempts to perform the procedure with fewer ports have been
 reported which include two-port techniques, single-port techniques, and hybrid approaches.
 The two-port appendectomy technique consist of one port providing access for a rigid
 telescope with a working channel, and second port for a grasping forceps that is used to
 retract the appendix. In the single-port assisted technique, after a stitch is placed between
 the appendix and the anterior abdominal wall to pull the appendix and create a tension to
 facilitate dissection, and then appendectomy is performed intracorporeally. The hybrid
 technique formed from the combination of both open and laparoscopic approaches. Namely the
 appendix is pulled out through the only or one of the port, and a traditional open
 appendectomy is then performed extracorporeally.

 The authors' primary objectives were to 1) identify a simple, safe and feasible way to
 perform laparoscopic appendectomy in patients with uncomplicated acute appendicitis. 2)
 determine the health related quality of life of the patients using Euro Qol (EQ) - 5
 Dimensions (5D) - 3 Levels (3L) (EQ-5D-3L) and Visual Analogue Scale (VAS) and calculate the
 cost per quality adjusted life years (QALYs) gained after the procedures (LAA and TLA). 3)
 Purpose a surgical algorithm when approaching to acute appendicitis with the consideration of
 quality of health and cost. For these purposes, a case-control study was designed in January
 2015 to investigate these issues.
Inclusion Criteria:

 -  all acute appendicitis patients underwent total laparoscopic appendectomy or
 laparoscopic assisted appendectomy

 Exclusion Criteria:

 -  no written informed consent