Randomized clinical trial of laparoscopic versus open appendicectomy

Background: Laparoscopy in patients with a clinical suspicion of acute appe ndicitis has not gained wide acceptance, and its use remains controversial. Methods: In a randomized controlled trial of laparoscopic versus open appen dicectomy, 583 of 828 consecutive patients consented to participate. Three hundred and one patients were allocated to open appendicectomy and 282 pati ents to laparoscopy, 65 of whom required conversion to open appendicectomy. Length of stay in hospital was the primary endpoint, while operating time, postoperative morbidity, duration of convalescence and cosmesis were secon dary endpoints. Results: Intention-to-treat analysis revealed an equally short hospital sta y in the two groups (median 2 days). The median time to return to normal ac tivity (7 versus 10 days) and work (10 versus 16 days) was significantly sh orter following laparoscopy. Laparoscopy was associated with fewer wound in fections (P < 0.03) and improved cosmesis (P < 0.001), but the operating ti me was longer (60 versus 40 min). Laparoscopy was associated with more intr aperitoneal abscesses (5 versus 1 per cent) but, adjusted for a greater num ber of gangrenous or perforated appendices in this group, the difference fa iled to reach statistical significance. Conclusion: Hospital stay was equally short, whereas laparoscopic appendice ctomy was associated with fewer wound infections, faster recovery, earlier return to work and improved cosmesis.