LAPAROSCOPIC VERSUS OPEN APPENDECTOMY FOR SUSPECTED APPENDICITIS - A PROSPECTIVE-STUDY

Despite recent advances in minimally invasive surgery, laparoscopic ap pendicectomy has been questioned as a feasible method of treating pati ents with suspected appendicitis because open appendicectomy carries f ew risks and complications. Between February 1992 and January 1993 a n on-randomized prospective study comparing open and laparoscopic append icectomy was designed to assess differences in postoperative morbidity , pain, inpatient hospital stay and a return to normal lifestyle. One hundred and sixty-seven patients with suspected clinical appendicitis were assigned to open (n = 74) or laparoscopic (n = 93) appendicectomy . Six patients were excluded due to the presence of other significant pathology such that the appendix was not removed. Eighty-seven patient s underwent attempted laparoscopic appendicectomy, of which 81 were co mpleted. The diagnosis of appendicitis was confirmed histologically in 63.5% of patients undergoing open appendicectomy and 63% of patients undergoing laparoscopic appendicectomy. There were no significant diff erences in anaesthetic times, postoperative morbidity and analgesic re quirements. There was a significant reduction in both postoperative in patient stay (P < 0.0001) and time taken to return to work or normal a ctivities (P < 0.0001) for the laparoscopic group. The use of laparosc opy for patients with suspected appendicitis aids definitive diagnosis and should reduce the negative appendicectomy rate to an acceptable f igure. The results suggest that laparoscopic appendicectomy is safe an d offers advantages over open appendicectomy in the management of pati ents with suspected appendicitis.