A randomized comparison of gasless laparoscopic appendectomy and conventional laparoscopic appendectomy

Area of Science:

• Minimally Invasive Surgery
• Surgical Outcomes
• Health Economics

Background:

• Appendicitis remains a common surgical emergency.
• Laparoscopic appendectomy (LA) is standard, but gasless techniques are emerging.
• Comparing gasless laparoscopic appendectomy (GLA) with conventional LA is crucial for optimizing patient care and resource utilization.

Purpose of the Study:

• To compare clinical outcomes and cost-effectiveness of GLA versus conventional LA.
• To evaluate the feasibility and safety of GLA in patients with acute appendicitis.

Main Methods:

• A randomized controlled trial involving 100 patients with acute appendicitis.
• Patients were allocated to either GLA (n=50) or LA (n=50) groups.
• Demographics, surgical duration, conversion rates, postoperative complications, analgesic use, hospital stay, and costs were analyzed.

Main Results:

• No significant difference in operative duration (70.6 min GLA vs. 62.6 min LA).
• GLA had an 8% conversion rate; LA had 0% (P=0.138).
• Significantly reduced postoperative fentanyl consumption (P=0.019) and total hospital cost (P<0.001) in the GLA group.
• Hospital stay approached statistical significance (4.36 days GLA vs. 5.68 days LA, P=0.053).

Conclusions:

• Gasless laparoscopic appendectomy (GLA) is comparable to conventional LA in operative duration, complications, and hospital stay.
• GLA demonstrates a significant advantage in reduced hospital costs and potentially lower analgesic demand.
• GLA is a safe and feasible alternative surgical approach for selected patients with acute appendicitis.