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.


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).


CONCLUSIONS
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.
First Department of Propaedeutic Surgery, Hippokrateion Hospital of Athens, Athens Medical School, Athens, Greece. labsures@yahoo.com
Manousos M
MM
Konstadoulakis
Ilias P
IP
Gomatos
Pantelis T
PT
Antonakis
Andreas
A
Manouras
Konstantinos
K
Albanopoulos
Nikolaos
N
Nikiteas
Emmanuel
E
Leandros
John
J
Bramis
D000293:Adolescent; D000328:Adult; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies