**6. Conclusion**

In conclusion, laparoscopy seems to be as safe as open appendectomy for acute appendicitis. Laparoscopy has many advantages, such as higher diagnostic yield, fewer postoperative wound infections, less postoperative pain, shorter hospital stay, earlier return to normal and full activity, better cosmesis, and probably decreased late complications such as adhesion formation and incisional hernias. Also one cannot overemphasize the superior visualization of the abdominal cavity and the possibility of not only diagnosing other pathologies but also dealing with them without having to use a bigger incision. Fertile women can profit the most from these advantages. But also elderly, overweight and employed patients seem to profit from laparoscopy. If the safety of leaving a macroscopically innocent appendix in situ is clarified by future studies the value of laparoscopy as a diagnostic tool will be enhanced. One expects that the further expansion of laparoscopy will lead to much more experienced surgeons, and that the progress in technology will facilitate this approach even more in the future. The reported higher incidence of intraabdominal abscesses with laparoscopy in some series could be experience- or technique-related and is likely to decrease with the evolution of laparoscopic skills among surgeons that leads to more precise operative maneuvers, and the standardisation of surgical technique. The higher operative costs in most institutions can perhaps be outweighed by a shorter hospital stay, and quicker return to normal activities with the laparoscopic approach, as well as by the possible decrease in late complications. Operative costs themselves can be reduced by the application of reusable instruments, application of loops instead of staplers, and further reduction of operating times. Finally it is important to reduce negative laparoscopies. The exact role of imaging modalities, inflammatory parameters and scoring systems in this purpose has yet to be defined.
