Laparoscopic appendectomy is the preferred approach for appendicitis: a retrospective review of two practice patterns.
BACKGROUND
This study aimed to compare the results of laparoscopic appendectomy (LA) and open appendectomy (OA).


METHODS
A retrospective analysis of 264 patients who underwent appendectomy (155 LA and 109 OA) over an 8-year period was performed. The variables analyzed included patient data (white blood cell count [WBC], duration of symptoms, American Society of Anesthesiology [ASA] score), operating data (length of the procedure and pathology), postoperative data (postoperative complications and length of hospital stay), and total costs.


RESULTS
Patient demographic data (age and sex), preoperative WBC, duration of symptoms, and pathology all were similar in the two study groups. Six cases were converted to OA and included in the LA group data. There was no statistical difference in the average operative time between the LA (mean, 55.7 + or - 22.3 min; range, 20-128 min) and OA (mean, 58.9 + or - 23.7 min; range, 29-135 min) groups (95% confidence interval [CI] -8.8-2.43; p = 0.26). The overall incidence of minor and major complications was significantly less in the LA group (3.2%, five incidents) than in the OA group (17.4%, 19 incidents; p = 0.0043). The median length of hospital stay (LOS) was significantly shorter in the laparoscopic group (median, 2 days; range, 1-8 days) than in the open group (median, 3 days; range, 1-11 days; p < 0.001). The mean total cost was $5,663 in the laparoscopic group and $6,031 in the open group (non-significant difference of -$368; 95% CI, -$926-$190; p = 0.19).


CONCLUSIONS
The findings show that LA is associated with fewer complications and similar total costs compared with OA. Therefore, LA can be recommended as a preferred approach to appendectomy.
Nakhamiyayev
Vadim
V
Department of Surgery, New York Methodist Hospital, 506 Sixth Street, Brooklyn, NY 11215, USA.
Galldin
Lars
L
Chiarello
Mario
M
Lumba
Angela
A
Gorecki
Piotr J
PJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000191:economics / Q000379:methods*; D001064:Appendicitis / Q000191:economics / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome