Comparison between open and laparoscopic appendectomy in non-complicated appendicitis

BACKGROUND/OBJECTIVE: An extensive web search failed to provide studies from Puerto Rico regarding whether open (OA) or laparoscopic appendectomy (LA) should be performed for non-complicated appendicitis. Our goal is to compare these techniques in terms of time at operating room (OR), length of surgery, hospital stay, pain medication requirements, in-hospital complications and readmissions. METHODS: 126 patients (64 OA; 62 LA) with non-complicated appendicitis were studied retrospectively. Data obtained: demographics, CT-Scan use, surgery and operating room time, days in hospital, complications, diet commencement, pain medications doses, pathology and readmission. RESULTS: Difference was found in total time at OR (80.1+/-29 minutes OA; 105.7+/-22.6 LA) and in surgery length (41+/-28 OA; 48+/-16 LA), but not in hospital stay (2.1 days OA; 2.2 LA) nor in in-hospital complication rate. Negative appendectomy rate was 24% LA vs. 3% OA. Readmission rate was higher in OA with 5% wound infection rate. CONCLUSION: Techniques are similar in mean hospital stay, in-hospital complications, and pain medication requirements. LA had a higher negative appendectomy rate but of these patients five had surgical diagnosis of acute appendicitis and after appendectomy, signs and symptoms resolved; and two patients had interval appendectomies. As these patients were cured, the real negative appendectomy rate is 13%, similar to the historically accepted 16%. The other eight patients had an adequate diagnosis. We are concerned OA negative appendectomy rate is only 3%; we wonder if surgeons are waiting too long to operate patients. Readmission was higher in OA (wound infection rate of 5%). Although it takes more time in the OR, LA is as safe as OA, has a low rate of complications and lower readmission rate.

Experience with hand assisted laparoscopic surgery of the colon

BACKGROUND: Hand assisted laparoscopic colectomy (HALS) has been shown to have the advantages of laparoscopic colectomy in terms of pain, recovery and length of hospital stay. Studies have shown similar outcomes in laparoscopic colectomy as in open surgery. There is a learning curve to HALS, the operative time is longer, and it is more difficult than open surgery and requires specialized equipment. In this report we present our initial experience over a 2.5 year period using HALS for colon surgery for diverticulosis, polyps and colon cancer. METHODS: A retrospective review of office and hospital charts of patients undergoing HALS colectomy from June 2005 to January 2008 was performed at HIMA-San Pablo Hospital. Demographics, outcomes data including operative time, conversion rate to open surgery, reasons for conversion, time to start feedings, and length of stay were collected as well as staging and number of nodes for cancer patients. Complications are discussed along with comments pertinent to the experience of two surgeons going through the learning curves of LC and HALS colectomy. RESULTS: A total of 65 patients underwent attempted hand assisted laparoscopic colon resection. There were 33 males and 32 females between the ages of 26 and 87. Thirty-one patients underwent surgery for diverticulosis; 8 for pre-malignant lesions (large polyps or polyps with high grade dysplasia), and 26 for colon cancer. Mean operative time was 195 minutes (120 to 300); mean length of stay was six days (range 4-14 days). Conversion rate was (13.8%) overall; 21% during the first year and 10.8% after the first year. 5 (7.5%) of the patients in which HALS colon resection was completed had complications with prolonged length of stay. Patients without complication had an average length of stay of 4.5 days. The average number of lymph nodes was 14.8 (range 7-24); average length of specimens for diverticulosis was 17cm. Complications included postoperative bleeding in three patients...