Effectiveness of laparoscopic approach for acute appendicitis

Whether a laparoscopic approach is more effective for acute appendicitis than standard open appendectomy remains controversial.

Clinical records of the 95 consecutive patients who underwent appendectomy for acute appendicitis between April 2002 and December 2005 were reviewed retrospectively. Laparoscopic appendectomy was performed for 62 patients (LA group), while 33 underwent open appendectomy (OA group). At our institution, LA is a standard operative procedure for acute appendicitis, and OA underwent because of social reasons. Characteristics, operative factors, and postoperative course were compared between groups.

Age, gender, past appendicitis attacks managed conservatively, and preoperative white blood cell counts did not differ significantly. Pathologic severity of appendicitis was more advanced in the OA than LA group (gangrenous in 52% vs 21% respectively, p=0.009). Mean operative time was significantly longer in the LA than OA group (80 min vs 63 min respectively, p=0.012). Pre- and postoperative white blood cell counts did not differ between groups, but recovery from postoperative pain and fever was significantly earlier in the LA than OA group (p=0.0007 and 0.013, respectively). Postoperative wound infection was significantly less frequent in the LA (6%) than OA group (27%, p=0.01), while incidence of postoperative intraabdominal infection did not differ significantly. Two patients in the LA group had serious complications that required reoperation; postoperative bleeding from the coagulated mesoappendix in one, and perforation of the jejunum caused by electrocautery during trocar insertion in the other. Mean postoperative hospital stay was significantly shorter in the LA than OA group (6.7 and 14.4 days respectively, p=0.04). According to severity of appendicitis, LA had no advantages over OA for gangrenous appendicitis.

Laparoscopic appendectomy has some disadvantages, such as long operative time and possible of serious complications, but generally accelerates postoperative early recovery to shorten hospitalization.