title: Pure transvaginal appendectomy versus traditional laparoscopic appendectomy for acute appendicitis: a prospective cohort study.
abstract: OBJECTIVE
  This report describes the first cohort study comparing pure transvaginal appendectomies (TVAs) to traditional 3-port laparoscopic appendectomies (LAs).
  
  
  METHODS
  Between August 2008 and August 2010, 42 patients were offered a pure TVA. Patients who did not wish to undergo a TVA underwent a LA and served as the control group. Demographic data, operative time, length of stay, patient controlled analgesia (PCA) 12-hour-morphine utilization, complications, return to normal activity, and return to work were recorded.
  
  
  RESULTS
  Eighteen of 40 enrolled patients underwent a pure TVA. Two patients refused to participate in this study. Mean age (TVA: 31.3 ± 2.5 years vs. LA: 28.2 ± 2.3 years, P = 0.36), mean body mass index (TVA: 23.7 ± 1.2 kg/m2 vs. LA: 23.6 ± 0.7 kg/m2, P = 0.96) mean operative time (TVA: 44.4 ± 4.5 minutes vs. LA: 39.8 ± 2.6 minutes, P = 0.38), and mean length of hospital stay (TVA: 1.1 ± 0.1 days vs. LA: 1.2 ± 0.1 days, P = 0.53) were not statistically significant. However, mean postoperative morphine-use (TVA: 8.7 ± 2.0 mg vs. LA: 23.0 ± 3.4 mg, P < 0.01), return to normal activity (TVA: 3.3 ± 0.4 days vs. LA: 9.7 ± 1.6 days, P < 0.01), and return to work (TVA: 5.4 ± 1.1 days vs. LA: 10.7 ± 1.5 days, P = 0.01) were statistically significant. One conversion in the TVA group to a LA was necessary because of inability to maintain adequate pneumoperitoneum. Four complications were observed: 1 intraabdominal abscess and 1 case of urinary retention in the TVA group; 1 early postoperative bowel obstruction and 1 case of urinary retention in the LA group.
  
  
  CONCLUSIONS
  Pure TVA is a safe and well-tolerated procedure with significantly less pain and faster recovery compared to traditional LA.
authors.affiliation: Section of Gastrointestinal Surgery, Yale University School of Medicine, 40 Temple Street, Suite 7B, New Haven, CT 06510, USA. kurt.roberts@yale.edu
authors.forename: Kurt E
authors.initials: KE
authors.lastname: Roberts
authors.forename: Daniel
authors.initials: D
authors.lastname: Solomon
authors.forename: Tamar
authors.initials: T
authors.lastname: Mirensky
authors.forename: Dan-Arin
authors.initials: DA
authors.lastname: Silasi
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Duffy
authors.forename: Tom
authors.initials: T
authors.lastname: Rutherford
authors.forename: Walter E
authors.initials: WE
authors.lastname: Longo
authors.forename: Robert L
authors.initials: RL
authors.lastname: Bell
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome