Is laparoscopic appendectomy safe when performed in a low volume setting?

Background: Similar to global trends, laparoscopic appendectomy has gained favor across the Caribbean but there is a paucity of published data evaluating its outcomes in the region. This study seeks to document the outcomes of laparoscopic appendectomies performed by community surgeons in a low volume setting in the Caribbean.

Methods: Data were recorded prospectively from all consecutive laparoscopic appendectomies performed from June 1, 2006 to May 30, 2011. Complicated appendicitis was considered present when the appendix was gangrenous, perforated, phlegmonous and/or associated with a peri-appendiceal abscess. Data were analyzed using SPSS version 19.

Results: Appendectomies were performed by one of three surgeons in 167 patients (mean case volume 11 cases per surgeon per year) at mean age of 31.8 ±9.67 years and mean BMI of 29.3 ± 2.59 Kg/m(2). There was a 14% negative appendectomy rate. Of 143 patients with confirmed appendicitis, 73% were uncomplicated cases and 24% were complicated appendicitis. The mean operating time was 50.1 ±18.4 minutes for uncomplicated cases and 98.8 ±21.6 minutes for complicated appendicitis. The overall morbidity rate was 4.2% (1.8% morbidity in uncomplicated cases and 14.7% for complicated appendicitis. Post-operatively, 69% patients required no supplemental parenteral opioids. After discharge, 7% patients required no oral analgesia and 90% stopped their analgesics within 48 hours.

Conclusions: Laparoscopic appendectomy is a safe operation when performed by community surgeons at low volumes and should be considered as a part of the surgical armamentarium.