I kind of agree with this, that is, if I think the patient probably has appendicitis, I recommend lap appy on obese patients. I give moderate sized patients a choice of lap or open appy, and I generally advise thin patients to have open appy (less total incision, just as quick back to work, definitely less time). I do, though, take out the appendix incidentally if I am operating for presumed (possible) appendicitis. (I dictate it this way, that is, if the patient has mesenteric adenitis, I dictate it as incidental appy.) If I do a diagnostic laparoscopy for female pelvic pain, I do a lap incidental appy (through the single umbilical incision) if I possibly can. I also willingly do lap incidental appys on any lap chole or lap hyster patient that requests one.