A PROSPECTIVE RANDOMIZED TRIAL COMPARING OPEN VERSUS LAPAROSCOPIC APPENDECTOMY

Objective The authors determined whether there was an advantage to lap aroscopic appendectomy when compared with open appendectomy. Summary/B ackground Data The advantages of laparoscopic appendectomy versus open appendectomy were questioned because the recovery from open appendect omy is brief. Methods From January 15, 1992 through January 15, 1943, 75 patients older than 9 years were entered into a study randomizing t he choice of operation to either the open or the laparoscopic techniqu e. Statistical comparisons were performed using the Wilcoxon test. Res ults Thirty-seven patients were assigned to the open appendectomy grou p and 38 patients were assigned to the laparoscopic appendectomy group . Two patients were converted intraoperatively from laparoscopic appen dectomies to open procedures. Thirty-one patients (81%) in the open gr oup had acute appendicitis, as did 32 patients (84%) in the laparoscop ic group. Mean duration of surgery was 65 minutes for open appendectom y and 87 minutes for laparoscopic appendectomy (p < 0.001). There were no statistically significant differences in length of hospitalization , interval until resumption of a regular diet, or morbidity. Duration of both parenteral and oral analgesic use favored laparoscopic appende ctomy (2.0 days versus 1.2 days, and 8.0 days versus 5.4 days, p < 0.0 5). All patients were instructed to return to lull activities by 2 wee ks postoperatively. This occurred at an average of 25 days for the ope n appendectomy group versus 14 days for the laparoscopic appendectomy group (p < 0.001). Conclusions Patients who underwent laparoscopic app endectomies have a shorter duration of analgesic use and return to ful l activities sooner postoperatively when compared with patients who un derwent open appendectomies. The authors consider laparoscopic appende ctomy to be the procedure of choice in patients with acute appendiciti s.