LAPAROSCOPY NOT RECOMMENDED FOR ROUTINE APPENDECTOMY IN MEN - RESULTSOF A PROSPECTIVE RANDOMIZED STUDY

Background. Laparoscopic appendectomy has now gained wider acceptance in clinical practice, particularly in the treatment of women with righ t iliac fossa pain. However, the precise role of laparoscopic appendec tomy in men is unclear, and this study was therefore undertaken to exa mine this specific issue in a prospective randomized trial. Methods. O ne hundred men between the ages of 16 and 65 years who had suspected a ppendicitis were recruited and randomized to undergo either open or la paroscopic appendectomy. Both groups were compared in terms of their c linical parameters, duration of anesthetic and operation times, postop erative pain, duration of ileus, and length of hospital stay. Results. The histologic confirmation of appendicitis was present in 94% of the cases for both groups of patients. Laparoscopic appendectomy required significantly longer anesthetic time (72.5 minutes versus 55 minutes) and actual operating time (45 minutes vers rcs 25 minutes) compared w ith open appendectomy. Postoperative pain as measured by visual analog scale on postoperative days 1 and 2 were not significantly different between the patients who underwent laparoscopic and open surgery with values of 4.7 versus 4.4 and 2.1 versus 2.2, respectively. Also no sig nificant difference was seen between the laparoscopic and open appende ctomy groups in the recovery of bowel function (24.7 hours versus 21 h ours) and in the length of hospital stay (4.9 days versus 5.3 days). C onclusions, The results of this prospective randomized trial showed th at there were no significant advantages of laparoscopic appendectomy o ver open appendectomy for the treatment of male patients with suspecte d appendicitis. We recommend that the use of laparoscopy be limited to men with atypical pain of uncertain diagnosis and in obese patients.