Laparoscopic versus open appendectomy: results of a retrospective comparison in an Israeli hospital.
BACKGROUND
Acute appendicitis is one of the most common conditions requiring surgical intervention. Open appendectomy has been a safe and effective operation for acute appendicitis for more than a century. Recently, several authors proposed that the new technique of laparoscopic appendectomy should be the preferred treatment for acute appendicitis. However, unlike laparoscopic cholecystectomy, LA has not yet gained popularity.


OBJECTIVE
To compare open with laparoscopic appendectomy for length of operation, complications, postoperative pain control, length of hospitalization, and hospital costs.


METHODS
A sample of 194 patients who underwent OA and LA during 1995 was randomly selected for the study. Patients' demographic data, preoperative laboratory and physical values, histopathologic diagnosis of removed appendix, mean operating time, length of hospitalization, and postoperative pain control and complications were reviewed.


RESULTS
Acute appendicitis was confirmed in 66% of patients. The groups were similar demographically (gender and mean age). We could not find any statistical differences in intraoperative and postoperative complications and use of antibiotics. The operative time was longer in the OA group (62.4 vs. 57.3 minutes), but the difference was not statistically significant (P = 0.075). The hospital stay was 2.5 days in the LA group and 2.7 days in the OA group. Higher operative costs were observed in the LA group.


CONCLUSIONS
Laparoscopic appendectomy is comparable to open appendectomy with regard to complications, length of operation, hospital stay, but it is more costly. Laparoscopic appendectomy does not offer any significant benefit over the open approach.
Peiser
Jochanan G
JG
Soroka University Medical Center, Department of Health Policy and Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. jpeiser@bgumail.bgu.ac.il
Greenberg
Dan
D
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000009:adverse effects* / Q000191:economics*; D001064:Appendicitis / Q000191:economics* / Q000473:pathology / Q000601:surgery*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011897:Random Allocation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome