Laparoscopic versus open appendectomy: a prospective comparative study of 227 patients.
BACKGROUND
Although laparoscopic appendectomy is widely practiced in developed countries, still there are many questions regarding the advantages and disadvantages of this approach in the treatment of acute appendicitis. Several controlled trials have been conducted, some in favor of laparoscopic appendectomy others not. The aim of this study was to evaluate laparoscopic appendectomy in comparison with open appendectomy, with special emphasis on postoperative septic complications.


METHODS
For this study, 227 consecutive patients (159 males and 68 females) with a diagnosis of suspected appendicitis between 1995 and 1999 were assigned either to laparoscopic appendectomy (n = 108) or open appendectomy (n = 119). The patients were assigned according to insurance company approval and patient preference. There were no exclusion criteria and no age limits in this study.


RESULTS
Wound infection was significantly higher in the open group (incidence, 7.6%) than in the laparoscopic group (incidence, 0%; p <0.003). Intraabdominal infections were equal in both groups. Hospital stay was significantly shorter in the laparoscopic group (p <0.046), but operative time was little longer than in the open group (p <0.002). Conversion to open surgery was necessary in one case.


CONCLUSIONS
Laparoscopic appendectomy is as safe and effective as the open procedure. It significantly reduces the rate of postoperative wound infection. However, it is still acceptable to perform the open procedure, especially in hospitals without a large amount of laparoscopic experience.
Marzouk
M
M
Department of Surgery, Saudi German Hospitals Group--Jeddah, Saudi Arabia. marzouk_sg20@yahoo.com
Khater
M
M
Elsadek
M
M
Abdelmoghny
A
A
D018784:Abdominal Abscess; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D001064:Appendicitis / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D013530:Surgical Wound Infection; D013997:Time Factors