Laparoscopic vs open appendectomy in overweight patients

Background: Laparoscopic appendectomy (LA) has been associated with a faste r recovery and less postoperative pain than the open technique. However, fe w data are available on the clinical outcome of LA in overweight patients. Methods: A group of 106 patients with ii body mass index (BMI) > 26.4, repr esenting the upper quintile of 500 prospectively randomized patients, were included in the study. They were randomized to undergo either laparoscopic or open appendectomy (OA), Operating and anesthesia times, postoperative pa ins complications, hospital stay, functional index (1 week postoperatively) , sick leave, and time to full recovery were documented. Results: In OA, the operating time for overweight patients was significantl y longer than that: for patients in the normal weight range (40 vs 35 min, p < 0.05). In LA, there was no difference in operating time between the nor mal and overweight patients. Overweight patients who underwent LA had longe r operating and anesthesia times than their OA counterparts (55 vs 40 min, p < 0.001; and 125 vs 100 min, p < 0.001, respectively). Postoperative pain was significantly greater in overweight patients who underwent OA than in those treated with the laparoscopic technique. Postoperative pain was also significantly greater in overweight patients subjected to OA than in patien ts of normal weight after 4 weeks; the clinical significance may, however, be of less importance since the values are low (0.26 vs 0.09, p <less than> 0.05). There were no significant differences between the two operating tec hniques in terms of complications. Hospital stay was longer for overweight patients than for normal-weight patients undergoing OA (3.0 vs 2.0, p < 0.0 1). The functional index did not differ between any group of patients. Sick leave was longer for overweight patients who underwent OA than for normal- weight patients treated with the same technique (17 vs 13 days, p < 0.01). In the laparoscopic group, however, there were no differences between the o verweight and normal-weight patients. Time to full recovery was greater in overweight patients subjected to OA than in the overweight patients in the LA group (22 vs 15 days, p < 0.001). Conclusion: In this study, overweight patients who were submitted to LA had less postoperative pain and a faster postoperative recovery than overweigh t patients who had Oh. LA also abolished some of the negative effects that overweight had on operating time, hospital stay, and sick leave with the op en technique. However, anesthesia and operating times were significantly lo nger in LA for both overweight patients and those with a normal BMI.