LAPAROSCOPIC VERSUS CONVENTIONAL APPENDECTOMY

Objective The goal of this study was to prospectively define the impac t of laparoscopy on the management of patients with a presumed diagnos is of appendicitis. Summary Background Data While the role of laparosc opy in the management of cholelithiasis is well established, its impac t on the management of acute appendicitis needs to be objectively defi ned and compared to that of conventional management. Several authors h ave predicted that laparoscopic appendectomy will become the preferred treatment for appendicitis. Methods Two groups of consecutive patient s with similar clinical characteristics of acute appendicitis were com pared. Data on the laparoscopic group were compiled prospectively on s tandardized forms; data on the conventional group were collected retro spectively. Operative time, hospital stay, analgesia, cost, and return to normal activities were noted. Results Seventeen consecutive patien ts who underwent appendectomy were compared to 18 consecutive patients who underwent laparoscopy (16 of these 18 had laparoscopic appendecto my). There was no significant difference between the two groups in ter ms of clinical characteristics and appendiceal histopathology. The mea n operative times were 61 +/- 4.1 minutes and 46 +/- 2.9 minutes for t he laparoscopy and conventional groups, respectively (p < 0.01). Hospi tal stay was significantly shorter in the laparoscopic appendectomy gr oup, with 81% of patients being discharged on their first postoperativ e day (p < 0.001). The laparoscopic appendectomy patients required sig nificantly less narcotic analgesia (p < 0.02). Return to normal activi ty was not significantly different between the two groups. The average total cost of laparoscopic appendectomy was 30% greater than that of conventional appendectomy. Conclusions Laparoscopy is a useful adjunct to the management of patients with a presumed clinical diagnosis of a cute appendicitis.