Dear Mr Gravante,

"Techniques in Coloproctology" could be a solution, especially if your manuscripts are of more technical substance, as I can understand.

Open appendectomy is still practiced and will continue to do so as conversions may always be needed in some situations. In Sweden 60% of all appendectomies are open and I think it is a developped country. The fact that the practice of open appendectomy is decreasing bring an increasing need of good studies that describe and evaluate different techniques as new generations will have less experience of it.

So that argument is not valid. Go on to the next journal.

Our prospective national audit of appendicectomy at 95 centres in the UK (approx 3400 cases) showed an initial open rate of 33% plus a further 11% of those started laparoscopically were converted to open.

This paper has been accepted by the BJS and should appear online in the near future. You could cite this in your communications with the journal(s) involved, and/or in the background or discussion of your revised paper

Good luck

Tom

Thank you, can you provide me with the complete reference please? (Authors, title, journal etc.) even at my personal email: [email protected]

I look forward to reading the national audit mentioned above. Personally I feel that comparison between open and laparoscopic appendiectomy is a valid study, I see little benefit in the laparoscopic approach apart from marginal improvement in cosmesis.

Open surgery can be done through a very small incision and would be much cheaper than laparoscopically. Comparative wound infection rates are also debatable. One particular benefit of laparoscopy of course is the ability to examine the rest of the abdomen.

sir you have raised avalid point. I would like to ask you whether open or laproscopic approach is decided by the doctor or patient. Is the cosmetic appearance more important than suturing. have we played ourselves into the hands of optical gaints.

Here is the link to our recently published national UK audit (mentioned above):

http://www.bjs.co.uk/details/article/5007671/Multicentre-observational-study-of-performance-variation-in-provision-and-outcom.html

Thanks for all your contributions.

Dear Gianpiero,

This topic will always stay actual, as it affects millions of pts around the world each year. So, it is important! No doubt about that. Getting your job published depends mainly of the way of the presentation of the data and discussion. As an editor and reviewer in various journals I see the widespread policy of editorial teams to publish more and more sophisticated papers abandoning sometimes important and practical ones which do not seem “scientifically” important. If your papers are presented like “Failed laparoscopic appendectomy – which conversion technique?” or “Closing the stump after conversion from laparoscopic to open appendectomy” they will look more actual, irrespective that you do not need to change nothing important in your papers generally, as your research results will always be based on open technique.

Better diagnostic accuracy of RIF pain will lead to a greater reduction in negative appendicectomies - so lots of areas of research left!!! Research never ceases...

I am doing nearly all my appendectomies open (small incisions 3 to 5 cm, most of time just a little larger as the trocard incision for the stapler). All my colleges are doing their appendectomies laparoscopic. They are no different hospitalisation time and different complication rate. (I am collecting the complication rate for our clinic and so may make a comparison).

The only cases I'm doing laparoskopicaly are: 1) very obese Patient, 2) if diagnosis are not clear so I'm doing a diagnostic laparoscopy and appendectomy, 3) if patient absolutely a laparoscopic appendectomy wants.

I think that a study like ours is very interesting because an open appendectomy cost certainly less then an laparoscopic approach, and if the results are similar I think we have to take the method with less cost