L. A. Bouvy While the advantages of laparoscopic cholecystectomy are beyond doubt, skepticism remains regarding laparoscopic appendectomy (LA). The laparoscopic approach in this case does not provide such obvious advantages, since the hospital stay is already short and the incision is small. However, in very obese patients, the benefit may be obvious, since LA can be safely performed after diagnostic laparoscopy. M. Heinzelmann (Zurich) [1] in 1995, comparing LA with open appendectomy (OA), somewhat prematurely declared LA as the gold standard. He based his conclusions on a comparative analysis of the treatment results of 102 patients who underwent LA and 204 patients who underwent OA. The duration of surgery for LA and OA was 83 and 64 min, respectively, nutrition was resumed after 2.6 and 4.1 days, respectively, and patients were discharged after 5.6 and 7.6 days, respectively. LA and OA had almost the same number of complications; in 18 cases it was necessary to switch from LA to OA. R. Frazee [2] came to the conclusion that LA is less painful and that a more rapid resumption of work is possible after it, so he made LA his standard technique. However, due to the unacceptably high frequency of intra-abdominal abscesses after LA for perforated appendicitis, further studies had to be conducted. Between 1991 and 1995, LA was performed for acute appendicitis 237 times, with 15 cases of gangrenous appendicitis and 19 cases of perforated appendicitis. In the gangrenous appendicitis group, the average surgical time was 85 minutes, with a postoperative hospital stay of 2 days. Percutaneous abscess drainage was required in 1 case. LA for perforated appendicitis averaged 84 minutes, but the postoperative hospital stay lasted 7 days, primarily due to the need for antibiotic treatment, delayed nutrition, and infectious complications. An 82-year-old patient died of septic shock and multiple organ failure. Thus, the benefits of LA in these cases were negated, and the authors therefore recommend promptly proceeding to OA when perforated appendicitis and pus are detected in the free abdominal cavity. In his commentary, Rosser, somewhat softening the conclusion, points out that with perforated appendicitis, morbidity and mortality, regardless of the method of intervention, are significantly higher, and the results of this series in this regard do not look much worse. References: 1. Heinzelmann M, Simmen HP, Cummins AS, Largiader F. Is laparoscopic appendectomy the new "Gold Standard"? Arch Surg 1995;130:782-5. 2. Frazee RC, Bohannon WT. Laparoscopic appendectomy for complicated appendicitis. Arch Surg 1996;131:509-12.