Laparoscopy in the contemporary management of acute appendicitis.
BACKGROUND
We sought to compare laparoscopic appendectomy (LA) with open appendectomy (OA) focusing on the negative appendectomy rate (NAR), emergency department (ED) to operating room (OR) time, procedure length, and histopathological correlation.


METHODS
All appendectomies for appendicitis over a 6-year period at a single hospital were reviewed. Open and laparoscopic procedures were compared.


RESULTS
There were 1,312 appendectomies (54.6% OA and 45.4% LA) Mean ED to OR time was as follows: LA 10.8 hours (standard deviation [SD] +/- 9.0) versus 9.8 hours (SD +/- 8.5) OA (P = .0333). Mean OR time was 61.2 minutes (SD +/- 29.1) LA versus 57.7 minutes (SD +/- 28) OA (P = .0293). NAR was 18.3%, LA 23.3% versus 14.0% OA (P < .0001). Postoperative correlation with histopathology was 86% for LA versus 92% OA (P = .0003). In the LA group, 9.9% with a "normal" appendix had appendicitis by histopathology.


CONCLUSIONS
LA is associated with increased presentation to procedure time, operative time, and negative appendectomy rate. Removing a "normal" appendix during LA in the absence of alternate pathology is recommended.
Ekeh
Akpofure Peter
AP
Department of Surgery, Wright State University, CHE 7000, Miami Valley Hospital, 1 Wyoming Street, Dayton, OH 45459, USA. peter.ekeh@wright.edu
Wozniak
Curtis J
CJ
Monson
Benjamin
B
Crawford
Joseph
J
McCarthy
Mary C
MC
D000328:Adult; D017677:Age Distribution; D001062:Appendectomy / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000175:diagnosis / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D017678:Sex Distribution; D016896:Treatment Outcome