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Article
July 1997

Laparoscopic vs Open AppendectomyProspective Randomized Study of Outcomes

Author Affiliations

From the Department of Surgical Education, St Joseph Hospital, Denver, Colo.

Arch Surg. 1997;132(7):708-712. doi:10.1001/archsurg.1997.01430310022003
Abstract

Objective:  To compare open appendectomy (OA) with laparoscopic appendectomy (LA) for length of the operation, complications, postoperative pain control, length of hospitalization, postdischarge recovery time, and hospital charges.Design:Prospective randomized clinical trial of patients with acute appendicitis.

Setting:  Tertiary care, urban teaching hospital.

Patients:  A population-based sample of patients (aged ≥ 12 years; weight, >49.7 kg) admitted to a surgical teaching service with a clinical diagnosis of acute appendicitis. Patients were prospectively randomized to either OA or LA during a 20-month period (from April 1, 1994, to December 31, 1995). Fifty-seven patients were initially enrolled in the study; 7 did not complete the study because of a protocol violation. All remaining patients completed the study, including postdischarge follow-up.

Interventions:  Two (7.4%) of the 27 patients in the LA group required conversion to OA because of technical difficulties. One patient (in the OA group) underwent a second surgical procedure for drainage of a pelvic abscess. Three patients (in the LA group) required second surgical procedures. For analysis, no crossovers were allowed and all patients remained in their originally randomized group.

Main Outcome Measures:  Length of the operation, intraoperative and postoperative complications, postoperative pain control, length of hospitalization, postdischarge recovery time, and hospital charges.

Results:  Fifty patients (19 women and 31 men) were examined. Twenty-seven patients underwent LA, 2 requiring conversion to an OA. Twenty-three patients underwent an OA. Patient demographics were similar between groups. Statistical differences between the 2 groups were found for (1) length of the operation (median, 81.7 vs 66.8 minutes, LA vs OA group; P<.002), (2) operating room charges (median, $3191 vs $1514, LA vs OA group; P<.001), and (3) total hospital charges (median, $5430 vs $3673, LA vs OA group; P<.001). No statistical differences between the 2 groups were found for (1) length of hospitalization (median, 1.1 vs 1.2 days, LA vs OA group), (2) pain control (mean, 4 vs 3.7 of 10 [0 indicates least pain; 10, most pain], LA vs OA group), (3) recovery time (time necessary before returning to work or school) (median, 14.0 days for both groups), and (4) complications (5 vs 1, LA vs OA group).

Conclusions:  Laparoscopic appendectomies and OAs are comparable for complications, postoperative pain control, length of hospitalization, and recovery time. Patients who underwent an OA had a shorter operative time and lower operating room and hospital charges. Laparoscopic appendectomy does not offer any proved benefits compared with the open approach for the routine patient with acute appendicitis.Arch Surg. 1997;132:708-712

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