Comparison of open and laparoscopic treatment of acute appendicitis

Background: Appendectomy can be performed using either a laparoscopic or an open technique. This study compares the outcome of patients treated for ac ute appendicitis by open appendectomy with the outcome of those undergoing laparoscopic appendectomy. Methods: Patients undergoing appendectomy at The Mount Sinai Hospital betwe en 1994 and 1998 were studied. Outcome of patients having open appendectomy was compared with that of patients having laparoscopic appendectomy. Results: Seven hundred fifty-eight patients underwent appendectomy for acut e appendicitis during the 5-year study period. Two hundred seventy-one (36% ) had open appendectomy and 487 (64%) had laparoscopic appendectomy. Patien ts subsequently found to have a normal appendix had the highest rate of lap aroscopic appendectomy, whereas those with gangrenous appendicitis were mos t likely to have open appendectomy (P <0.05). There was a significant decli ne in the postoperative length of stay for open cases during the length of the study. In the final year, the difference in length of stay between open and laparoscopic appendectomy was only 1 day. Patients with gangrenous app endicitis had a significantly longer length of stay than did patients with a normal appendix or suppurative appendicitis. The hospital cost of laparos copic appendectomy was greater than that for open appendectomy but the extr a expenditure in the operating room was offset by the longer length of stay of the patients having open surgery. Conclusions: Differences in outcome between open and laparoscopic appendect omy are minor. In this study, more difficult cases with gangrenous appendic itis were more likely to require open appendectomy whereas milder forms of appendicitis, especially in women, were more likely to be treated by laparo scopy. Savings from the slightly shorter hospital stay after laparoscopic a ppendectomy are offset by the higher surgical cost of the laparoscopic equi pment. (C) 2001 Excerpta Medica, Inc. Ali rights reserved.