Should appendectomy be performed laparoscopically? Clinical prospective randomized trial

Abstract

Objective: Laparoscopic appendectomy (LA) has been described in 1983, and its superiority over open appendectomy (OA) is still being debated. Currently, there is no agreement on the advantages of LA. Postoperative pain is reported to be lower along with a faster return to normal activities in LA. However, some studies do not support these findings. In our study, we aimed to compare the outcomes and cost effectiveness of LA and OA. Material and Methods:Patients were prospectively randomized into LA (31 patients) and OA (32 patients) groups. Demographic data, pre-and postoperative C-reactive protein (CRP) levels, white blood cell (WBC) count, duration of surgery and hospitalization, complications, and pain scores (VAS) were recorded. Cost was calculated for both groups. Return to normal activities was evaluated by phone calls at the first and second week and 1 month after surgery.Results: There was a significant postoperative decrease in WBC count in the LA group (p<0.01). There were no differences between LA and OA groups in terms of postoperative CRP levels (p>0.05). The rates of wound infection and abscess were similar (p>0.05), while post-operative pain and time to return to normal activities were higher in the OA group (p<0.01). There was a positive correlation between BMI and operative time in the LA group (p<0.01), while BMI and operative time did not show a correlation in the OA group (p>0,05). The average cost in the LA and OA groups were 1960.5±339.05 and 687.115±159.5 TL, respectively. Conclusion:LA is an effective method in the treatment of acute appendicitis due to less pain and faster recovery. LA can be the choice of treatment in acute appendicitis, with utilization of re-useable and cheaper vascular sealing devices.

Comparison of Laparoscopic and Open Appendectomy in Clinical Results and Cost: A Single Center Experience.

“…Another study conducted by Rohr et al (15) reported increased number of wound site infections in the LA group. Mantoglu et al (16) determined that the wound site infection was localized at the trocar site where the appendix is extracted from the abdomen, and contamination of the skin by the appendectomy piece that is too large to fit inside the trocar, and suggested that risk of wound site infection could be minimized by placing the appendix inside a protective bag while extracting it from the abdomen in such cases. In our study, wound infection was defined as stage 1 according to Clavien-Dindo classification which was found in 21 patients in LA group, and 102 patients in OA group.…”

“…The higher cost associated with LA was attempted to be reduced by preferring reusable endoscopic tools. Mantoglu et al (16) succeeded in partially reducing the cost by using a special set comprised of reusable trocar and hand tools and knots they had prepared using 2.0 polyglycolic acid suture instead of utilizing preformed knots. In our study, the main cause of the difference in costs between the groups was the vessel closure and sealing device.…”

Spinal/epidural block as an alternative to general anesthesia for laparoscopic appendectomy: a prospective randomized clinical study.

“…Categorical variables – sex, ASA, MSB level, drain usage, pathologic diagnosis, intraoperative and postoperative adverse events, and patient satisfaction – were evaluated as patient numbers and percentages. Based on a previous study [ 6 ], VAS on the 1 st postoperative day was 1.61 ±0.95 after the laparoscopic appendectomy under general anesthesia. Power analysis with α = 0.05 and β = 0.2 for detecting 50% reduction in VAS after laparoscopic appendectomy under spinal/epidural anesthesia revealed that each group required a minimum of 22 patients.…”

Laparoskopi̇k Yardimli Mi̇ni̇mal İnvazi̇v Apendektomi̇

“…The camera is introduced from one of these and grasper is inserted from the other one, then the appendix is caught and both trocars are pulled out together (Figure 2 subject of many discussions. According to the results obtained from the studies conducted, the place of laparoscopic endoscopy has not been clarified yet (6)(7)(8).…”