Comparison of open and laparoscopic treatment of acute appendicitis

ABSTRACT

Appendectomy can be performed using either a laparoscopic or an open technique. This study compares the out come of patients treated for acute appendicitis by open appendectomy with the outcome of those undergoing laparoscopic appendectomy. Patients undergoing appendectomy at Benha university Hospitals between January 1998 and Sept. 2001 were studied. Out come of patients having open appendectomy was compared with that of patients having laparoscopic appendectomy. Three hundred seventy nine [379] patients underwent appendectomy for acute appendicitis during the above mentioned period. One hundred thirty [130] pats. [34.3%] had open appendectomy and 249 [65.7%] had Laparoscopic appendectomy. Patients subsequently found to have a normal appendix had the highest rate of laparoscopic appendectomy, whereas those with gangrenous appendicitis were most likely to have open appendectomy [P<0.05]. There was a significant decline in the postoperative length of stay for open cases during the length of the study. In the final year, the difference in length of stay between open and laparoscopic appendectomy was only 1 day. Patients with gangnenous 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 greater than that for open appendectomy, but the extra expenditure in the operating room was offset by the longer length of stay of the patients having open surgery. 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 where-as milder forms of oppendicitis, 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