[Hybrid NOS appendectomy (NA): clinical assessment of a new surgical technique]

INTRODUCTION, AIM AND METHOD: Consecutive female patients undergoing hybrid NOS appendectomy (NA - with prospectively collected data) and laparoscopic appendectomy (LA - with retrospectively registered data) were compared by means of a matched-pair analysis according to selected criteria such as patient age, BMI, ASA and previous operations showing a near-perfect congruence with the following aims to: 1) demonstrate the feasibility of NA and to estimate its general costs, and 2) elucidate the outcome of the two techniques using available perioperative parameters from daily clinical practice. In particular, operating time, complications, histopathological findings, postoperative hospital stay and analgesic scores were used for comparison. A gynaecological follow-up investigation was carried out on the day of discharge and after a medium-term time period of 4 weeks in the NA group, and 6 months postoperatively, patients of both groups were interviewed using a standardised questionnaire.

From 05/01/2008 to 02/28/2010, transvaginal NA (n = 30) was compared with the results of the conventional LA (n = 30) in 60 female patients with regard to the operative outcome. Overall, matched-pair analysis of LA with NA, the novel technique resulted in the assessment of basically comparable surgical procedures with regard to perioperative routine parameters and outcome. There were no intraoperative complications in either of the two approaches; conversion was not required in both techniques. In addition, there were no significant differences in operating time (p = 0.099), postoperative complications (p = 0.72) and analgesic scores (p = 0.33/0.46). Postoperative hospital stay was even slightly shorter in the NA group (p = 0.02). The costs of the two methods are almost identical if the same instruments are used. Patient interviews suggested a slightly faster recovery, greater satisfaction with the better cosmetic outcome as well as a reduced pain intensity in favour of transvaginal NA.

Provided that a well developed laparoscopic expertise exists, it turned out i) that there are no serious reasons to resist a quick inauguration and establishment of NA for selected cases as well as ii) even to facilitate further clinical distribution of NA. Further systematic data collection appears to be indicated to analyse long-term outcome as parameters of an appropriate quality assurance.