In those clinical settings where surgical expertise and equipment are available and affordable, diagnostic laparoscopy and LA (either in combination or separately) seem to have various advantages over OA. Some of the clinical effects of LA, however, are small and of limited clinical relevance. In spite of the mediocre quality of the available research data, we would generally recommend to use laparoscopy and LA in patients with suspected appendicitis unless laparoscopy itself is contraindicated or not feasible. Especially young female, obese, and employed patients seem to benefit from LA.
A quality of life comparison of laparoscopic and open approaches in acute appendicitis: a randomised prospective study.
The study aimed to evaluate the utility of a laparoscopic approach in the management of patients with right lower abdominal pain and in the quality of life after the operation.
                Patients with suspected appendicitis were included in the study. They were randomly assigned either to treatment with a traditional open approach or with a laparoscopic approach. The patients' data, including demographic data, complications and gastro-intestinal quality of life index scores, were collected at the 6th week and 6th month and compared between the groups.
                Overall, 83 appendectomies were performed. Other pathologies were ovulation bleeding, ovarian cyst, Meckel's diverticulum, ectopic pregnancy and leiomyoma of the uterus. Negative appendectomy rate was 7%. Severe infection occurred in five of the open group. The advantages of the laparoscopy also showed significantly in hospital stay (55.80 +/- 20.97 hours vs. 75.06 +/- 35.14 hours), the need for narcotics and in visual analog score, as well as in the gastrointestinal quality of life index (85.88 +/- 9.73 vs 101.30 +/- 9.31). The quality of life is still better in the long-term (95.14 +/- 8.45 vs 120.36 +/- 10.25). When the groups were compared according to the subgroups of gastro-intestinal quality of life index, except for disease-specific items, in all categories a significant improvement was seen in the laparoscopically treated patients. This improvement was observed in the follow-up period also. However, the hospital costs (987.50 +/- 77.25 USD vs. 406.27 +/- 100.59 USD) and operative time (56.25 +/- 10.9 vs. 49.41 +/- 11.76 minutes) still continued to be a problem for the laparoscopic group.
                Laparoscopic appendectomy is a safe method, which also has advantages of diagnostic procedure for other pathologies, a better quality of life both in the early and late period, and a short hospital stay. The important advantage is also seen in the late period with better quality of life.