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Appendectomy in the pre- and postlaparoscopic eras.

D B Nguyen¹, W Silen, R A Hodin

¹Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract

|August 24, 1999

Summary

Laparoscopic appendectomy significantly reduces hospital stays and operating room time, especially for severe appendicitis, with similar complication rates to open surgery. This approach offers clear benefits for patients with acute appendicitis.

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Area of Science:

Surgery
Gastroenterology

Background:

The role of laparoscopic appendectomy versus open appendectomy for acute appendicitis is debated, with some suggesting morbidity depends on appendicitis severity, not surgical approach.
This study reviews appendectomy experience to evaluate the laparoscopic technique's advantages and disadvantages in acute appendicitis.

Purpose of the Study:

To determine the benefits and drawbacks of laparoscopic appendectomy compared to open appendectomy.
To ascertain if the extent of appendicitis should influence the choice of surgical approach.

Main Methods:

A retrospective review of 1158 appendectomies performed between 1987 and 1997.
Patients were categorized by pathological findings and operative approach (open or laparoscopic).
Data analysis included operating room time, hospital stay, and complication rates across three distinct time periods.

Main Results:

Laparoscopic appendectomy showed a trend towards shorter operating room times (99 vs. 102 minutes) and a significant reduction in hospital stay (1.63 vs. 4.21 days).
In gangrenous/perforated appendicitis, laparoscopic surgery was significantly faster (98/115 vs. 120/125 minutes) and resulted in shorter hospital stays (1.8/3.0 vs. 4.0/9.0 days).
Complication rates were similar between laparoscopic (5.4%) and open (7.5%) appendectomies, with a decrease in delayed treatment for perforated cases over time.

Conclusions:

Laparoscopic appendectomy leads to a significant decrease in hospital stay with comparable postoperative morbidity to open appendectomy.
The laparoscopic approach is particularly beneficial for gangrenous or perforated appendicitis, reducing both operating time and length of hospitalization.