Abstract
OBJECTIVE: The authors determined whether there was an advantage to laparoscopic appendectomy when compared with open appendectomy. SUMMARY/BACKGROUND DATA: The advantages of laparoscopic appendectomy versus open appendectomy were questioned because the recovery from open appendectomy is brief. METHODS: From January 15, 1992 through January 15, 1993, 75 patients older than 9 years were entered into a study randomizing the choice of operation to either the open or the laparoscopic technique. Statistical comparisons were performed using the Wilcoxon test. RESULTS: Thirty-seven patients were assigned to the open appendectomy group and 38 patients were assigned to the laparoscopic appendectomy group. Two patients were converted intraoperatively from laparoscopic appendectomies to open procedures. Thirty-one patients (81%) in the open group had acute appendicitis, as did 32 patients (84%) in the laparoscopic group. Mean duration of surgery was 65 minutes for open appendectomy and 87 minutes for laparoscopic appendectomy (p < 0.001). There were no statistically significant differences in length of hospitalization, interval until resumption of a regular diet, or morbidity. Duration of both parenteral and oral analgesic use favored laparoscopic appendectomy (2.0 days versus 1.2 days, and 8.0 days versus 5.4 days, p < 0.05). All patients were instructed to return to full activities by 2 weeks postoperatively. This occurred at an average of 25 days for the open appendectomy group versus 14 days for the laparoscopic appendectomy group (p < 0.001). CONCLUSIONS: Patients who underwent laparoscopic appendectomies have a shorter duration of analgesic use and return to full activities sooner postoperatively when compared with patients who underwent open appendectomies. The authors consider laparoscopic appendectomy to be the procedure of choice in patients with acute appendicitis.
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- Berry J., Jr, Malt R. A. Appendicitis near its centenary. Ann Surg. 1984 Nov;200(5):567–575. doi: 10.1097/00000658-198411000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Browne D. S. Laparoscopic-guided appendicectomy. A study of 100 consecutive cases. Aust N Z J Obstet Gynaecol. 1990 Aug;30(3):231–233. doi: 10.1111/j.1479-828x.1990.tb03220.x. [DOI] [PubMed] [Google Scholar]
- Deutsch A. A., Zelikovsky A., Reiss R. Laparoscopy in the prevention of unnecessary appendicectomies: a prospective study. Br J Surg. 1982 Jun;69(6):336–337. doi: 10.1002/bjs.1800690615. [DOI] [PubMed] [Google Scholar]
- Dunn E. L., Moore E. E., Elerding S. C., Murphy J. R. The unnecessary laparotomy for appendicitis-can it be decreased? Am Surg. 1982 Jul;48(7):320–323. [PubMed] [Google Scholar]
- Frazee R. C., Roberts J. W., Okeson G. C., Symmonds R. E., Snyder S. K., Hendricks J. C., Smith R. W. Open versus laparoscopic cholecystectomy. A comparison of postoperative pulmonary function. Ann Surg. 1991 Jun;213(6):651–654. doi: 10.1097/00000658-199106000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Frazee R. C., Thames T., Appel M., Roberts J., Symmonds R., Snyder S., Hendricks J., Smith R., Allen T. W. Laparoscopic cholecystectomy: a multicenter study. J Laparoendosc Surg. 1991 Jun;1(3):157–159. doi: 10.1089/lps.1991.1.157. [DOI] [PubMed] [Google Scholar]
- Graves H. A., Jr, Ballinger J. F., Anderson W. J. Appraisal of laparoscopic cholecystectomy. Ann Surg. 1991 Jun;213(6):655–664. doi: 10.1097/00000658-199106000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Leahy P. F. Technique of laparoscopic appendicectomy. Br J Surg. 1989 Jun;76(6):616–616. doi: 10.1002/bjs.1800760631. [DOI] [PubMed] [Google Scholar]
- Leape L. L., Ramenofsky M. L. Laparoscopy for questionable appendicitis: can it reduce the negative appendectomy rate? Ann Surg. 1980 Apr;191(4):410–413. doi: 10.1097/00000658-198004000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lewis F. R., Holcroft J. W., Boey J., Dunphy E. Appendicitis. A critical review of diagnosis and treatment in 1,000 cases. Arch Surg. 1975 May;110(5):677–684. doi: 10.1001/archsurg.1975.01360110223039. [DOI] [PubMed] [Google Scholar]
- Nowzaradan Y., Westmoreland J., McCarver C. T., Harris R. J. Laparoscopic appendectomy for acute appendicitis: indications and current use. J Laparoendosc Surg. 1991 Oct;1(5):247–257. doi: 10.1089/lps.1991.1.247. [DOI] [PubMed] [Google Scholar]
- Peters J. H., Ellison E. C., Innes J. T., Liss J. L., Nichols K. E., Lomano J. M., Roby S. R., Front M. E., Carey L. C. Safety and efficacy of laparoscopic cholecystectomy. A prospective analysis of 100 initial patients. Ann Surg. 1991 Jan;213(1):3–12. doi: 10.1097/00000658-199101000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pier A., Götz F., Bacher C. Laparoscopic appendectomy in 625 cases: from innovation to routine. Surg Laparosc Endosc. 1991 Mar;1(1):8–13. [PubMed] [Google Scholar]
- Schirmer B. D., Edge S. B., Dix J., Hyser M. J., Hanks J. B., Jones R. S. Laparoscopic cholecystectomy. Treatment of choice for symptomatic cholelithiasis. Ann Surg. 1991 Jun;213(6):665–677. doi: 10.1097/00000658-199106000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schirmer B. D., Schmieg R. E., Jr, Dix J., Edge S. B., Hanks J. B. Laparoscopic versus traditional appendectomy for suspected appendicitis. Am J Surg. 1993 Jun;165(6):670–675. doi: 10.1016/s0002-9610(05)80785-8. [DOI] [PubMed] [Google Scholar]
- Scott-Conner C. E., Hall T. J., Anglin B. L., Muakkassa F. F. Laparoscopic appendectomy. Initial experience in a teaching program. Ann Surg. 1992 Jun;215(6):660–668. doi: 10.1097/00000658-199206000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]