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At least 19 recordsLinked to original sources
PubMed1995

A prospective, randomized comparison of laparoscopic appendectomy with open appendectomy. Laparoscopic Appendectomy Study Group.

BACKGROUND: While the advantages of laparoscopic cholecystectomy are clear, the benefits of laparoscopic appendectomy (LA) are more subtle. We conducted a randomized clinical trial to evaluate whether LA is deserving of more widespread clinical application than it has yet received. MATERIALS AND METHODS: Two hundred fifty-three patients with a preoperative diagnosis of acute appendicitis were randomized into three groups. LA with an endoscopic linear stapler (LAS) (U.S. Surgical Corp., Norwalk, Connecticut) was performed on 78 patients, LA with catgut ligatures (LAL) on 89, and open appendectomy (OA) on 86. LA was performed with a three-trocar technique. OA was accomplished through a right lower-quadrant transverse incision. Data with normal distributions were analyzed by analysis of variance. Nonparametric data were analyzed with either the Kruskal-Wallis H test or Fisher's exact test. RESULTS: The mean operative times for the procedures were 66 +/- 24 minutes (LAS), 68 +/- 25 minutes (LAL), and 58 +/- 27 minutes (OA). The relative brevity of OA compared to LAS and LAL was statistically significant (P < 0.01). Conversion to open procedures was approximately as frequent in the LAS group (n = 5) and the LAL (n = 6). One OA, 2 LAS, and 11 LAL patients experienced vomiting postoperatively (P < 0.05). Two intra-abdominal abscesses occurred in LAS, 4 in LAL, and 0 in OA patients (P = NS). Wound infections were more common following OA (n = 11) than LAL (n = 4) or LAS (n = 0) (P < 0.05, < 0.001). The mean length of postoperative hospital stay was 2.16 +/- 3.2 days (LAS), 2.98 +/- 2.7 days (LAL), and 2.83 +/- 1.6 (OA) (P < 0.05 OA versus LAS). The number of days patients required pain medications overall was not different between groups, but a subgroup analysis of 134 patients who rated their postoperative pain on a visual analogue scale revealed a significantly lower mean level among patients undergoing LA (LAS and LAL) versus OA (P < 0.001). Patients undergoing LA resumed regular activities sooner than those undergoing OA (9 +/- 9 days versus 14 +/- 11 days, P < 0.001). Rates of readmission to the hospital were similar for all procedures. CONCLUSIONS: Laparoscopic appendectomy appears to have distinct advantages over open appendectomy. The laparoscopic procedures produced less pain and allowed more rapid return to full activities, and LAS required shorter hospital stays. The only disadvantages to the laparoscopic approach were slightly increased operative time for both procedures, and increased emesis following LAL.

Adult↗
PubMed1993

[Does laparoscopic appendectomy have advantages? Laparoscopic appendectomy in comparison with conventional appendectomy--an observational study during introduction of laparoscopy].

From October 1990 to October 1992 the first 23 laparoscopically operated patients were recorded. 11 patients retrospectively including a supplementary questioning to missing data, 12 patients prospectively with a follow-up 6-8 weeks later. They were compared with 35 from April 1991 to April 1992 conventionally operated and prospectively observed patients. Laparoscopy was performed on patients with subacute clinical signs. The median age was comparable. Acute appendicitis was histologically confirmed in 18% of the laparoscopically and in 80% of the conventionally operated patients. Operating time was in mean 110 minutes for laparoscopic and 65 minutes for open appendectomy. The postoperative complications for laparoscopy included 4 Douglas abscesses (2 x open and 2 x pararectal revisions), one peritonitis due to a defect Roeder-loop and an haematoma of the abdominal wall. One case of wound infection (3%), one pericoecal abscess which needed an ileoascendostomy and a postoperative fatigue syndrome were recorded for open appendectomy. The postoperative return to normal diet was faster for laparoscopy. Return to normal bowel habits, the need of analgesia and the nominal analogue scales concerning pain, quality of sleep, well-being and appetite showed no obvious differences between the two operation methods. The postoperative stay was on average 6.7 days for laparoscopy and 5.6 days for the open operation. The results show the severe complications which may happen when introducing this new operation method. The laparoscopic appendectomy should only be performed electively in subacute appendicitis or when diagnostic exploration shows an inflamed appendix. Careful rinsing of the operation site and perioperative antibiotic treatment are mandatory. We made good experiences when using a stapler for the removal of the appendix.

Adolescent↗
PubMedDate not supplied

Comparison of laparoscopic-assisted appendectomy with intracorporal laparoscopic appendectomy and open appendectomy.

BACKGROUND: A laparoscopic appendectomy is associated with less postoperative pain and a shorter postoperative stay than the open technique. However, the open technique is faster and less expensive than the completely laparoscopic method. A laparoscopic-assisted appendectomy has the advantages of both the laparoscopic and open techniques. METHODS: A retrospective study involving 83 patients was performed comparing the three different techniques. The comparison studied operating time, surgical expense, and postoperative stay. RESULTS: The completely laparoscopic method was performed on 24 patients with an average surgical time of 88.9 minutes, average charges of $604, and average postoperative stay of 2.6 days. The open technique was performed on 26 patients with a surgical time of 77.1 minutes, charges of $42, and a postoperative stay of 2.4 days. The laparoscopic-assisted technique was performed on 33 patients with a surgical time of 70.3 minutes, charges of $208, and a postoperative stay of 1.8 days. CONCLUSION: The laparoscopic-assisted method of appendix removal can be performed as efficiently as the open technique but at <67% of the cost of the complete laparoscopic method. The postoperative stay is shorter for the laparoscopic-assisted technique than for the open technique. Thus, the laparoscopic-assisted technique is a cost-effective method for removing the appendix.

Adolescent↗
PubMed1997

Histopathologic analysis of interval appendectomy specimens: support for the role of interval appendectomy.

The treatment of appendiceal abscess is controversial. For patients initially treated "conservatively" with antibiotics with or without drainage, the role of interval appendectomy is an area of considerable debate. Without interval appendectomy, the true risks of recurrent disease and missed pathological findings are uncertain, and large, long-term, prospective studies are unavailable. To evaluate the role of interval appendectomy, the authors reviewed the histopathologic specimens from patients with presumed appendiceal abscess treated by interval appendectomy. Over a 7-year period, 162 children presented with a clinical diagnosis of perforated appendicitis. Eighteen patients had localized abscesses treated conservatively, followed by interval appendectomy. Standard histopathologic sections of 17 of the 18 appendices were examined by one pathologist who was blinded to the clinical data and to the interpretation of the original pathologist. Of the 11 boys and seven girls (mean age, 7.4 +/- 3.4 years), eight underwent percutaneous drainage and one underwent operative drainage. All received intravenous antibiotics for a mean of 8.6 +/- 3.2 days with a hospital stay of 10.4 +/- 8.3 days. Interval appendectomy was performed at a mean of 92.7 +/- 20.7 days after initial admission, with discharge at a mean of 2 +/- 1.3 days after surgery. There were no complications or deaths. Histopathologic review showed normal appendix (n = 4), normal appendix with mild serositis (n = 6), normal appendix with unsuspected resolved Meckel's diverticulitis (n = 1), appendiceal duplication (n = 1), granulomatous appendicitis (n = 3), and acute appendicitis (n = 2). All appendices had patent lumens, and 15 were documented to be present to the tip. There was no correlation between the histopathologic findings and the interval between abscess and interval appendectomy. Interval appendectomy was performed with no morbidity and a short hospital stay. Two patients had histopathologic recurrent acute appendicitis, five had unsuspected pathological findings (appendiceal duplication, Meckel's diverticulitis, granulomatous inflammation), and none of the appendices had an obliterated lumen, suggesting that all patients were at long-term risk for recurrent disease. These data support the role of interval appendectomy in cases of perforated appendicitis treated conservatively.

Abscess↗
PubMed2006

Two-trocar laparoscopic-assisted appendectomy versus conventional laparoscopic appendectomy in patients with acute appendicitis.

BACKGROUND: In order to reduce abdominal trauma and operative costs we have adopted a two-trocar laparoscopic-assisted appendectomy for patients with acute appendicitis. In the current study, the proposed technique is prospectively evaluated against conventional laparoscopic appendectomy with respect to feasibility, safety, and postoperative outcome. MATERIALS AND METHODS: Between July 2001 and July 2003, 83 consecutive patients were admitted with clinically diagnosed acute appendicitis and were randomly assigned to two-trocar laparoscopic-assisted appendectomy (n = 40, 48.2%) or conventional laparoscopic appendectomy (n = 43, 51.8%). RESULTS: Two-trocar laparoscopic-assisted appendectomy was successfully completed in 30 patients (80.1%). Four patients initially scheduled for two-trocar laparoscopic-assisted appendectomy (10.8%) were converted to laparotomy due to excessive body weight (BMI > or = 40), while an additional 5-mm infraumbilical trocar was inserted in another 3 patients (8.1%). The procedure was associated with decreased operative time and more rapid return to normal activity compared to laparoscopic appendectomy (P < 0.001 and P = 0.038, respectively). There was no statistically significant difference regarding the duration of hospitalization or the morbidity rate between the two groups. Conversion of the initial procedure was associated with increased wound infection rate and higher morbidity (P = 0.032 and P = 0.018, respectively). CONCLUSION: Two-trocar laparoscopic-assisted appendectomy represents a promising minimally invasive procedure for the treatment of acute appendicitis. It is fast and easy to perform, and it is expected to decrease the overall cost of laparoscopic appendectomy. Its only contraindication is excessive body weight; it remains to be evaluated in the setting of perforated appendicitis and retrocecally located appendices.

Adolescent↗
PubMed2001

A prospective randomized comparison of laparoscopic appendectomy with open appendectomy: Clinical and economic analyses.

BACKGROUND: Previous randomized studies of laparoscopic appendectomy produced conflicting recommendations, and the adequacy of sample sizes is generally unknown. We compared clinical and economic outcomes after laparoscopic and open appendectomy in a sample of predetermined statistical power. METHODS: A pre-study power analysis suggested that 200 randomized patients would yield 80% power to show a mean decrease of 1.3 days' hospitalization. One hundred ninety-eight patients with a preoperative diagnosis of acute appendicitis were randomized prospectively to laparoscopic or open appendectomy. Economic analysis included billed charges, total costs, direct costs, and indirect costs associated with treatment. RESULTS: Laparoscopic appendectomy took longer to perform than open appendectomy (median, 107 vs 91 minutes; P <.01) and was associated with fewer days to return to a general diet (mean, 1.6 versus 2.3 days; P <.01), a shorter duration of parenteral analgesia (mean, 1.6 versus 2.2 days; P <.01), fewer morphine-equivalent milligrams of parenteral narcotic (median, 14 mg versus 34 mg; P =.001), a shorter postoperative hospital stay (mean, 2.6 versus 3.4 days; P <.01), and earlier return to full activity (median, 14 versus 21 days; P <.02). However, operative morbidity and time to return to work were comparable. Billed charges and direct costs were not significantly different in the 2 groups ($7711 versus $7146 and $5357 versus $4945, respectively), but total costs (including indirect costs) of laparoscopic appendectomy were, on average, nearly $2400 less, given the shorter length of stay and abbreviated recuperative period ($11,577 versus $13,965). Subgroup analyses suggested the benefit of a laparoscopic approach for uncomplicated appendicitis and for patients with active lifestyles. CONCLUSIONS: While laparoscopic appendectomy is associated with statistically significant but clinically questionable advantages over open appendectomy, a laparoscopic approach is relatively less expensive. The estimated difference in total costs of treatment (direct and indirect costs) was at least $2000 in more than 60% of the bootstrapped iterations. The economic significance and implications favoring a laparoscopic approach cannot be ignored.

Appendectomy↗
PubMed2005

[Elective standard appendectomy versus elective laparoscopic appendectomy in women. A retrospective study].

AIM: Comparison of open appendectomy and laparoscopic appendectomy with focus on the wound infectious complications. METHODS: Retrospective comparison of the early postoperative complications of the elective open and elective laparoscopic appendectomy in the Surgical Clinics of the Teaching Hospital Hradec Králové in period January 2001-July 2004. RESULTS: 250 elective appendectomies in women were performed in followed period. 187 (75%) were done by laparoscopic approach, 63 (25%) by open procedure. Conversion was necessary in 18 cases (9.6%). The average hospital stay was statistically significantly shorter following laparoscopic than open appendectomy, 4.6 +/- 1.5 days counter to 6.1 +/- 1.6. The global morbidity was comparable in both groups 15%, one patient died (0.5%) in laparoscopic appendectomy group. The incidence of early postoperative complications was not statistically different in both groups. CONCLUSIONS: The average hospital stay was statistically significantly shorter following laparoscopic appendectomy. Laparoscopic appendectomy did not improve the results regarding infectious complications and was a cause of serious complications. Some of them required operational revision.

Adolescent↗
PubMedDate not supplied

Laparoscopic appendectomy versus open appendectomy: a single institution study.

PURPOSE: The purpose of this study was to compare the safety and efficacy of laparoscopic appendectomy versus open appendectomy at Baptist Hospital in Miami, Florida. METHODS: A retrospective review was performed on all appendectomies performed at Baptist Hospital from October 1, 1994 to September 30, 1995. There were a total of 244 cases; 137 open appendectomies and 107 laparoscopic appendectomies. The cases were reviewed with regard to pathology, operating time, length of hospital stay and complications. RESULTS: The pathologic findings at surgery were similar for the two groups. Concomitant pathology was more likely to be found laparoscopically than in open surgery. There was a greater percentage of ruptured appendices in surgery done via the open method. Operative time was slightly longer, but complications were less in the laparoscopic group. Length of stay was lower in the laparoscopic appendectomy group. CONCLUSIONS: Although very similar, our method of appendectomy favors the laparoscopic technique.

Adult↗
PubMed1996

Laparoscopic appendectomy. A comparison with open appendectomy.

PURPOSE: As laparoscopy becomes a greater part of a general surgeon's practice, each new application must be analyzed. The purpose of this article is to report a four-year experience with laparoscopic appendectomy, with special attention to complications. METHODS: All patients undergoing appendectomy by members of the General Surgery Department of Columbia Hospital between December 20, 1990, and December 24, 1994, were included (n = 434). Medical records were reviewed, and data were analyzed using multiple regression analysis, analysis of variance, and Pearson's chi-squared test. RESULTS: The number of post-operative intra-abdominal abscesses following laparoscopic appendectomy tended to be higher; however, this did not reach statistical significance. Conversely, all other complications combined demonstrated a rate of 4.3 percent for laparoscopic procedures and a rate of 8.5 percent for open procedures. Again this tended toward, but did not reach, statistical significance. Advantage in length of stay was approximately two days, with a mean length of stay for patients undergoing laparoscopic appendectomy of 3.3 days, whereas that for open appendectomy was 5.7 days. CONCLUSION: Laparoscopic appendectomy has significant advantages in terms of patient comfort and length of stay, and its overall complication rate seems to be lower than with open procedures; however, its rate of intra-abdominal abscess may actually be higher. Further study is recommended.

Adolescent↗
PubMed2006

Laparoscopic appendectomy for perforated appendicitis: a comparison with open appendectomy.

BACKGROUND: The role of laparoscopic appendectomy for perforated appendicitis remains controversial. This study aimed to compare laparoscopic and open appendectomy outcomes for children with perforated appendicitis. METHODS: Over a 36-month period, 111 children with perforated appendicitis were analyzed in a retrospective review. These children were treated with either laparoscopic (n = 59) or open appendectomy. The primary outcome measures were operative time, length of hospital stay, time to adequate oral intake, wound infection, intraabdominal abscess formation, and bowel obstruction. RESULTS: The demographic data, presenting symptoms, preoperative laboratory values, and operative times (laparoscopic group, 61 +/- 3 min; open group, 57 +/- 3 were similar for the two groups (p = 0.3). The time to adequate oral intake was 104 +/- 7 h for the laparoscopic group and 127 +/- 12 h for the open group (p = 0.08). The hospitalization time was 189 +/- 14 h for the laparoscopic group, as compared with 210 +/- 15 h for the open group (p = 0.3). The wound infection rate was 6.8% for the laparoscopic group and 23% for the open group (p < 0.05). The wounds of another 29% of the patients were left open at the time of surgery. The postoperative intraabdominal abscess formation rate was 13.6% for the laparoscopic group and 15.4% for the open group. One patient in each group experienced bowel obstruction. CONCLUSIONS: Laparoscopic appendectomy for the children with perforated appendicitis in this study was associated with a significant decrease in the rate of wound infection. Furthermore, on the average, the children who underwent laparoscopic appendectomy tolerated enteral feedings and were discharged from the hospital approximately 24 h earlier than those who had open appendectomy.

Appendectomy↗
PubMedDate not supplied

[Comparative study of laparoscopic appendectomy vs open appendectomy].

UNLABELLED: Laparoscopy reduces the risk of performing unnecessary appendectomies and offers the advantages of minimal invasive surgery when appendectomy is needed. We report our experience comparing open (Group A) with laparoscopic (Group B) appendectomy. PATIENTS AND METHODS: There were 20 patients in each group. Age, sex, signs, symptoms, evolution, laboratory, stage of disease, drains, duration of surgery, antibiotics, oral intake restart, postoperative pain at 24, 48 and 72 hours, complications, hospital stay, return to normal activities and cosmesis were reviewed. Statistical differences were determined using Student's t test (two tailed) or chi-square with Yates correction. Surgical technique is described. RESULTS: In both groups most variables were similar (p = ns). Group B presented earlier oral intake restart (p < 0.001), and less postoperative pain at 24 (p < 0.001), 48 (p < 0.01) and 72 hours (p < 0.001). Hospitalization stay was shorter (p < 0.001) and return to normal activities was earlier (p < 0.001) in group B. Better cosmetical appearance was observed in Group B (16 vs. 0 "excellent" -p < 0.001). CONCLUSIONS: Laparoscopic approach may reduce unnecessary appendectomies and it allows to perform appendectomy in a safe and effective way. In this study, laparoscopic was better than open appendectomy regarding early restart of oral intake, less postoperative pain, shorter hospitalization stay, earlier return to normal activities and better cosmetic appearance.

Adolescent↗
PubMed1989

[The mobile cecum syndrome: appendectomy and cecopexy or only appendectomy?].

1159 patients underwent appendectomy via a McBurney incision from 1972 to 1983 at our institution. 115 patients (10%) had a mobile cecum syndrome (CMS) as defined by Nicole, without evidence of appendicitis or other pathologic findings at operation. 102 patients were followed up to 15 years after the operation. 82% of the 102 patients were free of symptoms at assessment. 36 patients underwent appendectomy and 63 appendectomy and cecopexy. The two cohorts were comparable with respect to sex, age at operation, duration of right lower abdominal pain, operative findings and length of follow-up. There was no significant difference in the postoperative result of patients with appendectomy alone and those with appendectomy and cecopexy. Moreover, we were not able to identify patients who may benefit from an additional cecopexy, on the basis of patient related factors or intraoperative findings.

Adolescent↗
PubMed1997

Early appendectomy versus an interval appendectomy for appendiceal abscess in children.

We retrospectively compared the results of an early appendectomy and an interval appendectomy at a later date after initial conservative treatment in children demonstrating perforated appendicitis with a localized abscess. The preoperative conditions were similar for both groups. The early group (n = 8) showed a statistically significant longer operation time and a greater but not significant blood loss were noted while a larger number of postoperative complications were also observed. On the other hand, in the late operation group (n = 6) initial conservative management including triple antibiotic therapy proved successful without the need to drain the abscess, and thus the interval appendectomy was safely completed without any complications. There were no significant differences between the two groups with respect to length of hospital stay or medical costs. Based on these findings, we thus recommend that initial conservative treatment followed by an interval appendectomy about three months later is a useful strategy for the treatment of appendiceal abscesses in children. However, whether or not an interval appendectomy is appropriate in all patients whose inflammation is suppressed with antibiotics still needs to be clarified.

Abdominal Abscess↗
PubMed2005

Comparison of needlescopic appendectomy versus conventional laparoscopic appendectomy: a randomized controlled trial.

Laparoscopic appendectomy has been shown to improve postoperative recovery when compared with open appendectomy. The present randomized trial was conducted to evaluate any further difference in outcome between needlescopic appendectomy (NA) and conventional laparoscopic appendectomy (CLA) in the management of acute appendicitis. Patients with the clinical diagnosis of acute appendicitis were randomized to either NA (instrument size < or = 3 mm) or CLA (instrument size > or = 5 mm). Standardized anesthetic technique and perioperative management were adopted. The primary end point was length of postoperative hospital stay. Other parameters such as conversion rate, postoperative pain score and analgesic requirement, return of bowel function, resumption of normal activities, complication rate, and length of the final scars were also assessed and compared. A total of 363 patients (NA: 174, CLA: 189) were recruited. Both approaches could accurately arrive at the diagnosis (NA: 98.3%; CLA: 100%). Compared with CLA, NA resulted in a significantly longer operation time (P = 0.015) and a higher conversion rate (P < 0.001). The final scars of the NA group were significantly shorter when compared with the CLA group (P < 0.001). Otherwise, there was no statistical difference between the 2 groups in terms of complication rate, postoperative pain score, length of postoperative stay, and other recovery parameters. NA resulted in a longer operation time and higher conversion rate. Except for a smaller scar, the present study was unable to demonstrate any other short-term benefits. Thus, the technique cannot be routinely recommended.

Acute Disease↗
PubMedDate not supplied

[Laparoscopic appendectomy versus open appendectomy in suspected acute appendicitis in female patients].

INTRODUCTION: The aim of the study is to analyse the own data and try to discuss if laparoscopic appendectomy offers any advantages in treating young women suffering from pain in right lower abfdominal quadrant. MATERIALS AND METHODS: The study was conducted on 148 patients admitted from October 1993 to December 1998 with diagnosis of of pain in right iliac fossa and operated on with a laparoscopic (LA group: 75 cases) or open approach (OA group: 73 cases). Patients were prospectively randomized on the surgical approach adopted, following a randomized list. RESULTS: The operative time in LA group was significantly (p < 0.001) longer (87.2 minutes) than for OA group (65.2 minutes). In 2 patients (2.7%) the operation had to be converted. Diagnosis had remained unknown in 16 patients (21.9%) of OA group, in spite of only one case (1.4%) with laparoscopic technique. We didn't observed intraoperative complications. Pain in the first and second postoperative days, evaluated on the use of pain medication, was significantly less in patients in group LA (p < 0.01). There were no deaths. Postoperative complications occurred in 4 patients (5.5%) of group LA, and in 8 patients (10.9%) of group OA. Hospital stay was significantly shorter for those having laparoscopic appendectomy (p < 0.001). DISCUSSION: The main advantages of laparoscopic appendectomy consist more in diagnostic accuracy, than in less postoperative pain, less hospital stay and less postoperative complications. CONCLUSION: Laparoscopic appendectomy is a safe and accurate approach.

Acute Disease↗
PubMedDate not supplied

Laparoscopic appendectomy versus open appendectomy in children: another opinion.

Laparoscopic appendectomy (LA) is a commonly performed procedure that is a safe alternative to conventional open appendectomy (OA). LA offers reduced parietal scarring, a shortened hospital stay, and an earlier return to normal activities. During a 13-month period (July 2001 to July 2002), data were collected regarding appendectomies performed in 113 children (<18 years) in our hospital. Patients were divided into two groups according to type of appendectomy received (OA, N = 59 versus LA, N = 54). The operative time, length of hospital stay, and postoperative complications were compared between the two groups. Operative time was similar in the OA and LA groups (1.20 +/- 0.46 versus 1.12 +/- 0.36 hours, respectively; P = 0.328). Patients receiving OA had significantly longer hospital stays than those receiving LA (4.69 +/- 3.45 versus 3.07 +/- 1.93 days, respectively; P = 0.002). The complication rate associated with OA was higher than that observed for LA (6.8% versus 3.5%), but this difference was not significant (P = 0.681). Patients receiving LA could begin drinking water earlier after surgery than postflatus OA patients (12-24 hours versus 3.2 days). The OA group had a higher rate of ruptured appendicitis than the LA group (13/59 versus 2/54), but similar rates of normal appendix was observed in both groups (13/59 versus 13/54). Three patients in the LA group were switched to OA. Although patients who underwent LA did not experience a significant decrease in complications compared with OA patients, they did have shorter hospital stays and postoperative NPO times. Therefore, LA seems to be a safe operation in children. It is ideal for overweight, adolescent females and patients in whom appendicitis is suspected. LA is not recommended for those with an appendiceal mass.

Adolescent↗
PubMed1995

Laparoscopic appendectomy versus open appendectomy: retrospective assessment of 200 patients.

OBJECTIVE: To compare laparoscopic appendectomy (LA) with traditional methods as the primary treatment for acute appendicitis. DESIGN: A retrospective case series. SETTING: A regional, nonuniversity hospital in northwestern Quebec. PATIENTS: Two hundred patients with a clinical diagnosis of acute appendicitis: 100 (43 men, 57 women; mean age 27 years) underwent laparoscopic appendectomy and 100 (67 men, 33 women; mean age 21 years) had an open appendectomy (OA). INTERVENTIONS: LA or OA. MAIN OUTCOME MEASURES: Operating time, rate of conversion to OA, need for analgesia, morbidity and outcome. RESULTS: LA was successful in 88% of patients. The mean operating time was 50 minutes for LA versus 24 minutes for OA. On average, patients of the LA group had a 1-day decrease in postoperative hospital stay (2.6 versus 3.6 days). The wound infection rate was lower in the LA group (2% versus 12%) as was the intra-abdominal abscess rate (2% versus 6.0%). There were no deaths in either group. The overall morbidity was 4.5% for the LA group and 18% for the OA group. A clear tendency toward a shorter convalescence was seen in the LA group. CONCLUSIONS: LA is a safe and viable treatment alternative for acute appendicitis. Prospective randomized studies are needed to confirm its potential advantages.

Acute Disease↗
PubMed1996

Laparoscopic appendectomy: comparison with open appendectomy in 720 patients.

We conducted a review of laparoscopic appendectomies (LA) and open appendectomies (OA) over a 3-year period, including 720 patients (253 LA, 467 OA) who underwent appendectomy during the study period. Computer records were reviewed with respect to demographics, length of stay, operating room time, operating room cost, hospital cost, and morbidity. All patients were sent surveys to assess their posthospitalization recovery. The LA patients had significant shorter hospital stays (2.06 days vs. 3.44 days, p < .001), lower morbidity rates (5 vs 14%, p < .02), and comparable overall hospital costs ($4,800 vs. $4,950). The LA patients also reported less postoperative pain and were able to return to work sooner. Our results show that LA can significantly decrease morbidity and hospital stay with a comparable hospital cost and result in quicker patient recovery.

Adult↗