Comparison of Clinical Outcomes between Laparoscopic and Open Appendectomy: A Retrospective Analysis of 2,745 Patients

ABSTRACT

PURPOSE: Despite the reported advantages of laparoscopic appendectomy (LA), there is debate about the postoperative complication rates. Our study attempts to determine if laparoscopic appendectomy is safe and feasible compared with open appendectomy (OA). METHODS: A retrospective review was conducted of all patients who underwent open appendectomy (OA, 2,109 cases) and laparoscopic appendectomy (LA, 500 cases) at our hospital between 1997 and 2007. Incidental and interval appendectomies were excluded from this study. Demographic data, pathology, operation time, length of hospital stay, days to regular diet, and in hospital complication rate were identified. RESULTS: The peak age was 27 years. Seven of the 500 were converted to OA, yielding a conversion rate of 1.2%. The presence of non-visualized appendix, adhesion and technical failures were reasons for conversion. The distribution of histological stages of inflammation was comparable in both groups. The mean operating time was longer for the laparoscopic (64 min) than for the open procedure (58 min) (P<0.001). The complication rate after OA (7%) was significantly higher than that following LA (2.8%) (P=0.001). Hospital stay and frequency of analgesic administration were significantly lower in LA group than in OA group. CONCLUSION: Laparoscopic appendectomy is a safe and clinically beneficial operating procedure even in patients with appendicitis with peritonitis, perforation and abscess, resulting in shorter hospital stays and lower complication rates.