A team from New York, USA, compared the outcome of patients treated for acute appendicitis by open appendectomy with the outcome of those undergoing laparoscopic appendectomy.
Patients undergoing appendectomy for acute appendicitis at the Mount Sinai Hospital, between 1994 and 1998, were studied. A total of 758 patients were enrolled during the 5-year study period.
Of these, 271 (36%) had open appendectomy and 487 (64%) had laparoscopic appendectomy.
|Type of appendectomy used:|
Gangrenous appendicitis - open method
Milder forms - laparoscopic
| American Journal of Surgery |
Patients subsequently found to have a normal appendix had the highest rate of laparoscopic appendectomy. Those with gangrenous appendicitis were most likely to have open appendectomy.
The researchers found that there was a significant decline in the postoperative length of stay for open cases during the study period. In the final year, the difference in length of stay between open and laparoscopic appendectomy was only 1 day.
Patients with gangrenous appendicitis had a significantly longer length of stay than did patients with a normal appendix or suppurative appendicitis.
The hospital cost of laparoscopic appendectomy was found to be greater than that for open appendectomy. However, the longer length of stay of the patients having open surgery offset the extra expenditure in the operating room.
Author R. J. Kurtz, of the Mount Sinai Medical Center, New York, said on behalf of the group, "Differences in outcome between open and laparoscopic appendectomy are minor."
"In this study, more difficult cases with gangrenous appendicitis were more likely to require open appendectomy, whereas milder forms of appendicitis, especially in women, were more likely to be treated by laparoscopy.
"Savings from the slightly shorter hospital stay after laparoscopic appendectomy are offset by the higher surgical cost of the laparoscopic equipment," it was concluded.