LAPAROSCOPIC APPENDECTOMY - IS IT WORTH IT

Data on all laparoscopic appendectomies (LA) were collected prospectiv ely from June 1990 through July 1992 and compared retrospectively with all open appendectomies (OA) done at the same hospital during the sam e time period. Laparoscopic appendectomies were performed in 29 patien ts (ages 15-47, mean 25.3 years) and OA in 77 patients (ages 18-71, me an 31.9 years, P < 0.01). Preoperative findings were similar in the tw o groups. Acute appendicitis was confirmed in 22 (76%) LA and in 57 (7 4%) OA; of these, 9/22 (41%) LA and 23/57 (40%) OA were gangrenous or perforated. A normal appendix was removed in seven (24%) LA and in 20 (26%) OA. Three patients (10%) required conversion of LA to an open pr ocedure. Operative time was significantly longer for LA (mean 105 minu tes) compared with OA (mean 69 minutes; P < 0.001). Postoperative comp lications requiring further intervention (wound infection or intraabdo minal abscess) occurred in three LA (10%) and in 23 OA (30%, P < 0.05) . Wound morbidity as measured by number of wounds left open at surgery or opened for infection was significantly less after LA (14% LA, 39% OA, P < 0.001). Hospital stay was significantly shorter after LA (mean 4.2 days) compared with OA (mean 6.3 days; P < 0.05). Hospital charge s and professional fees were not significantly different between the t wo groups. In selected patients, LA is a safe, effective alternative t o OA, with fewer complications and shorter hospital stay. In addition, hospital charges are similar, making an investment of more time in th e operating yield an outcome equal or superior to OA.