Laparoscopic appendectomy as the gold standard: What role remains for open surgery, conversion, and disease severity?: An analysis of 32,000 cases with appendicitis in Germany

PMCID: PMC12178000

PMID: 40533760

DOI: 10.1186/s13017-025-00626-2

Journal: World journal of emergency surgery : WJES

Publication Date: 2025-6-18

Authors: Schildberg C, Weber U, König V, Linnartz M, Heisler S, et al.

Key Points

• Laparoscopic appendectomy became the predominant surgical approach, reaching >95% of procedures annually since 2017
• Conversion to open surgery was associated with 20.8% complication rate and increased mortality risk (OR 1.3)
• Patient-specific factors like age, comorbidities, and appendicitis severity are critical in predicting surgical outcomes and potential complications

Summary

This large-scale retrospective multicenter study analyzed 31,988 patients with acute appendicitis from 2010 to 2022, providing comprehensive insights into surgical management and outcomes. The research demonstrated a significant shift towards laparoscopic appendectomy, with 97% of procedures performed laparoscopically by 2017, establishing it as the gold standard for both uncomplicated and complicated appendicitis cases.

The study revealed nuanced findings about appendicitis severity, with 27.4% of cases classified as complicated. Surgical approach and patient characteristics significantly impacted outcomes, with conversion to open surgery associated with higher morbidity and mortality. Women demonstrated a lower risk of surgical conversion compared to men, and patient factors such as age, comorbidities, and specific appendicitis type influenced surgical risk.