Abstract
Background: The comparison of laparoscopic to open appendectomy has been reviewed in many retrospective and prospective studies. Some report shorter hospital stays, less postoperative pain, and earlier return to work while others fail to demonstrate such differences. We performed a prospective, randomized double-blinded trial to evaluate this ongoing debate. Methods: Fifty-two consecutive men presenting with signs and symptoms suggestive of acute appendicitis were randomized to undergo either laparoscopic appendectomy or open appendectomy. Length of operative times, hospital stay, lost work days, visual analog pain scores, and operative costs were compared. Results: Length of stay averaged 21.5 h for the laparoscopic group and was not statistically different when compared to the open group. Perceived postoperative pain on postoperative days 1 and 7 were not statistically different between the two groups. Mean time to return to work was 11 days, and there was no statistical difference between groups. Operative costs were >$600 greater for the laparoscopic approach. Conclusions: In this prospective randomized double-blinded trial, laparoscopic appendectomy appears to confer no significant advantage over open appendectomy for postoperative pain or lost work days. It does carry an increase in operating room costs and, contrary to other reports, hospital stay is not shortened. Further studies are needed to determine if specific populations, such as the obese or women, may benefit from a minimally invasive approach to appendicitis.
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References
K Apelgren R Molnar J Kisala (1995) ArticleTitleLaparoscopic is not better than open appendectomy. Am Surg 61 240–243 Occurrence Handle1:STN:280:ByqC1Mzpt1c%3D Occurrence Handle7887538
F Bonanni J Reed G Hartzell D Trostle R Boorse M Gittleman A Cole (1994) ArticleTitleLaparoscopic versus conventional appendectomy. J Am Coll Surg 179 273–278 Occurrence Handle1:STN:280:ByuA2cfmsVc%3D Occurrence Handle8069421
M Cox J McCall J Toouli R Padbury T Wilson D Wattchow M Langcake (1996) ArticleTitleProspective randomized comparison of open versus laparoscopic appendectomy in men. World J Surg 20 263–266 Occurrence Handle10.1007/s002689900041 Occurrence Handle1:STN:280:BymA38rmt1U%3D Occurrence Handle8661828
L Enochsson A Hellberg C Rudberg G Fenyo T Gudbjartson E Kullman I Ringqvist S Sorensen J Wenner (2001) ArticleTitleLaparoscopic vs open appendectomy in overweight patients. Surg Endosc 15 387–392 Occurrence Handle1:STN:280:DC%2BD38%2Fht1yiuw%3D%3D Occurrence Handle11395821
R Frazee J Roberts R Symmonds S Snyder J Hendricks R Smith M Custer J Harrison (1994) ArticleTitleA Prospective randomized trial comparing open versus laparoscopic appendectomy. Ann Surg 219 725–728 Occurrence Handle1:STN:280:ByuB28zjtVA%3D Occurrence Handle8203983
J Hansen B Smithers D Schache D Wall B Miller B Menzies (1996) ArticleTitleLaparoscopic versus open appendectomy: prospective randomized trial. World J Surg 20 17–20 Occurrence Handle10.1007/s002689900003 Occurrence Handle1:STN:280:BymC2cfjsVI%3D Occurrence Handle8588406
R Hart C Rajgopal A Plewes J Sweeney W Davies D Gray B Taylor (1996) ArticleTitleLaparoscopic versus open appendectomy: a prospective randomized trial of 81 patients. Can J Surg 39 457–462 Occurrence Handle1:STN:280:ByiC3MrktV0%3D Occurrence Handle8956810
L Martin I Puente J Sosa A Bassin R Breslaw M McKenney E Ginzburg D Sleeman (1995) ArticleTitleOpen versus laparoscopic appendectomy. A prospective randomized comparison. Ann Surg 222 256–261 Occurrence Handle1:STN:280:ByqH3cjpsF0%3D Occurrence Handle7677456
L McCahill C Pellegrini T Wiggins W Helton (1996) ArticleTitleA clinical outcome and cost analysis of laparoscopic versus open appendectomy. Am J Surg 171 533–537 Occurrence Handle1:STN:280:BymB2crht1U%3D Occurrence Handle8651403
D Mutter M Vix A Bui S Evrard V Tassetti J Breton J Marescaux (1996) ArticleTitleLaparoscopy not recommended for routine appendectomy in men: results of a prospective randomized study. Surgery 120 71–74 Occurrence Handle1:STN:280:BymA3cbktFQ%3D Occurrence Handle8693426
JB Olsen CJ Myren PE Haahr (1993) ArticleTitleRandomized study of the value of laparoscopy before appendicectomy. Br J Surg 80 922–930 Occurrence Handle1:STN:280:ByyA2sbosVE%3D Occurrence Handle8369940
O Reiertsen E Trondsen A Bakka O Andersen S Larsen A Rosseland (1994) ArticleTitleProspective nonrandomized study of conventional versusu laparoscopic appendectomy. World J Surg 18 411–415 Occurrence Handle1:STN:280:ByuA2sfmtlw%3D Occurrence Handle8091783
K Richards K Fisher J Flores B Christensen (1996) ArticleTitleLaparoscopic appendectomy: comparison with open appendectomy in 720 patients. Surg Laparosc Endosc 6 205–209 Occurrence Handle10.1097/00019509-199606000-00008 Occurrence Handle1:STN:280:BymA3szgtVQ%3D Occurrence Handle8743364
V Vallina J Velasco C McCulloch (1993) ArticleTitleLaparoscopic versus conventional appendectomy. Ann Surg 218 685–692 Occurrence Handle1:STN:280:ByuD2MfjvFY%3D Occurrence Handle8239785
CM Whitworth PW Whitworth J Sanfillipo H Polk (1988) ArticleTitleValue of diagnostic laparoscopy in young women with possible appendicitis. Surg Gynecol Obstet 167 187–190 Occurrence Handle1:STN:280:BieA387pvVU%3D Occurrence Handle2970682
M Williams Jr Collins T Wright M Fenoglio (1996) ArticleTitleLaparoscopic versus open appendectomy. South Med J 89 668–674 Occurrence Handle1:STN:280:BymB1MrpslA%3D Occurrence Handle8685751
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The Chief, Navy Bureau of Medicine and Surgery, Washington, DC, Clinical investigation Program sponsored this study (CIP #P00-058).
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Ignacio, R., Burke, R., Spencer, D. et al. Laparoscopic versus open appendectomy: What is the real difference? Results of a prospective randomized double-blinded trial. Surg Endosc 18, 334–337 (2004). https://doi.org/10.1007/s00464-003-8927-x
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DOI: https://doi.org/10.1007/s00464-003-8927-x