LAPAROSCOPIC VERSUS CONVENTIONAL APPENDECTOMY

BACKGROUND: The results of recent series suggest remarkable advantages of laparoscopic appendectomy over the conventional open appendectomy. To determine if clear advantages could be established, the charts of all patients admitted to our institution with a presumptive diagnosis of acute appendicitis and subsequent appendectomy were retrospectively reviewed. STUDY DESIGN: From January 1990 through June 1992, there we re 300 conventional open appendectomies and 66 laparoscopic appendecto mies performed. Data from both groups were compared with respect to an esthesia time, operative time, postoperative morbidity, postoperative pain, time to regular diet, hospitalization period, cost, and return t o normal activities. RESULTS: There were no significant differences be tween the laparoscopic and open appendectomy groups with respect to op erative complications, postoperative morbidity, pain medication requir ements, and time to regular diet. There were significantly longer anes thesia times, operative times, and operating room costs in the laparos copic group. For complicated appendicitis, the laparoscopic technique resulted in infectious complications that required readmission in 45.5 percent of the patients. CONCLUSIONS: Laparoscopic appendectomy is a safe alternative to conventional open appendectomy for simple acute ap pendicitis. However, laparoscopic appendectomy is not superior to the conventional method with regard to operative time, postoperative morbi dity, pain medication requirements, time to regular diet, length of st ay, cost, or return to normal activity. Laparoscopic appendectomy may be contraindicated in complicated appendicitis (gangrene, perforated w ith abscess, or peritonitis) due to an increased rate of infectious co mplications requiring readmission.