A PROSPECTIVE, RANDOMIZED COMPARISON OF LAPAROSCOPIC APPENDECTOMY WITH OPEN APPENDECTOMY

BACKGROUND: While the advantages of laparoscopic cholecystectomy are c lear, the benefits of laparoscopic appendectomy (LA) are more subtle. We conducted a randomized clinical trial to evaluate whether LA is des erving of more widespread clinical application than it has yet receive d. MATERIALS AND METHODS: Two hundred fifty-three patients with a preo perative diagnosis of acute appendicitis were randomized into three gr oups. LA with an endoscopic linear stapler (LAS) (U.S. Surgical Corp., Norwalk, Connecticut) was performed on 78 patients, LA with catgut li gatures (LAL) on 89, and open appendectomy (OA) on 86. LA was performe d with a three-trocar technique. OA was accomplished through a right l ower-quadrant transverse incision. Data with normal distributions were analyzed by analysis of variance. Nonparametric data were analyzed wi th either the Kruskal-Wallis H test or Fisher's exact test. RESULTS: T he mean operative times for the procedures were 66 +/- 24 minutes (LAS ), 68 +/- 25 minutes (LAL), and 58 +/- 27 minutes (OA). The relative b revity of OA compared to LAS and LAL was statistically significant (P <0.01). Conversion to open procedures was approximately as frequent in the LAS group (n = 5) and the LAL (n = 6). One OA, 2 LAS, and 11 LAL patients experienced vomiting Postoperatively (P <0.05). Two intra-abd ominal abscesses occurred in LAS, 4 in LAL, and 0 in OA patients (P = NS). Wound infections were more common following OA (n = 11) than LAL (n = 4) or LAS (n = 0) (P <0.05, <0.001). The mean length of postopera tive hospital stay was 2.16 +/- 3.2 days (LAS), 2.98 +/- 2.7 days (LAL ), and 2.83 +/- 1.6 (OA) (P <0.05 OA versus LAS). The number of clays patients required pain medications overall was not different between g roups, but a subgroup analysis of 134 patients who rated their postope rative pain on a visual analogue scale revealed a significantly lower mean level among patients undergoing LA (LAS and LAL) versus OA (P <0. 001). Patients undergoing LA resumed regular activities sooner than th ose undergoing OA (9 +/- 9 days versus 14 +/- 11 days, P <0.001). Rate s of readmission to the hospital were similar for all procedures. CONC LUSIONS: Laparoscopic appendectomy appears to have distinct advantages over open appendectomy. The laparoscopic procedures produced less pai n and. allowed more rapid return to full activities, and LAS required shorter hospital stays. The only disadvantages to the laparoscopic app roach were slightly increased operative time for both procedures, and increased emesis following LAL.