8_1 Acute_RASPANTI.qxp_-

Acute appendicitis (AA) is a common occurrence in the practice of an Emergency Surgery Unit (ESU) and the most common indication for emergency abdominal surgery with an estimated lifetime prevalence ranging around 10% (1-3). The conventional, laparotomic approach is still accepted, as reported in some studies based on surgical expertise (4). Many studies suggest that the laparoscopic approach for performing appendectomy (LA) has many advantages like faster recovery, less postoperative complications, better cosmetic impact, less postoperative pain and shorter hospital stay (5, 6). At first these advantages had been demonstrated in uncomplicated appendicitis (7). More recent experience (experiences) showed several advantages of LA even in complicated appendicitis, which should be considered, such as a minimally sized incision associated with a significantly lower incidence of surgical site infection (8, 9). The impact of the learning curve in the safety and effectiveness of LA has been evaluated (10), and it could be concluded that it is an optimal approach, but this study focused on how many procedures a surgeon may have to carry out before performing it independently; moreover, it concerns the learning curve of the residents and does not consider the skill of the senior surgeons in performing a laparoscopic procedure. In fact, in a realistic perspective, not all senior emergency surgeons achieve during their activities an acceptable level of competence in laparoscopic approach of abdominal emergencies even if they are not difficult to carry out. Laparoscopic approach in a Unit with frequent alternation of the surgical teams could be performed by competent surgeons and, on the contrary, avoided by less experienced operators. In our experience, laparoscopic approach of acute appendicitis is increasingly being favored following an internal audit since 2006 and progressively performed by all 6 senior surgeons of our Unit. The main aim of this study is to verify if this approach can become the SUMMARY: Acute appendicitis: should the laparoscopic approach be proposed as the gold standard? Six-year experience in an Emergency Surgery Unit.