HAS THE LAPAROSCOPIC APPENDECTOMY ADVANTA GES - A COMPARISON BETWEEN LAPAROSCOPIC AND CONVENTIONAL APPENDECTOMY - AN OBSERVATIONAL STUDY DURING THE INTRODUCTION OF LAPAROSCOPY

From October 1990 to October 1992 the first 23 laparoscopically operat ed patients were recorded. 11 patients retrospectively including a sup plementary questioning to missing data, 12 patients prospectively with a follow-up 6-8 weeks later. They were compared with 35 from April 19 91 to April 1992 conventionally operated and prospectively observed pa tients. Laparoscopy was performed on patients with subacute clinical s igns. The median age was comparable. Acute appendicitis was histologic ally confirmed in 18% of the laparoscopically and in 80% of the conven tionally operated patients. Operating time was in mean 110 minutes for laparoscopic and 65 minutes for open appendectomy. The postoperative complications for laparoscopy included 4 Douglas abscesses (2 x open a nd 2 x pararectal revisions), one peritonitis due to a defect Roeder-l oop and an haematoma of the abdominal wall. One case of wound infectio n (3%), one pericoecal abscess which needed an ileoascendostomy and a postoperative fatigue syndrome were recorded for open appendectomy. Th e postoperative return to normal diet was faster for laparoscopy. Retu rn to normal bowel habits, the need of analgesia and the nominal analo gue scales concerning pain, quality of sleep, well-being and appetite showed no obvious differences between the two operation methods. The p ostoperative stay was on average 6,7 days for laparoscopy and 5,6 days for the open operation. The results show the severe complications whi ch may happen when introducing this new operation method. The laparosc opic appendectomy should only be performed electively in subacute appe ndicitis or when diagnostic exploration shows an inflamed appendix. Ca reful rinsing of the operation site and perioperative antibiotic treat ment are mandatory. We made good experiences when using a stapler for the removal of the appendix.