Hospitalization costs of open vs. laparoscopic appendectomy: 5-year experience.

BACKGROUND: There is an ongoing debate over certain aspects of laparoscopic appendectomy (LA) over open appendectomy (OA) in regard to hospitalization costs and associated complications. METHODS: A database was used to obtain the charts for either LA or OA performed during a 5-year period. Variables analyzed were age, gender, hospitalization cost, length of stay and complications. RESULTS: Of 1792 appendectomies performed, 633 (35.3%) were OA and 1159 (64.6%) were LA. Both groups were statistically similar with regard to gender (p = 0.075) but differed with respect to age, demonstrating an older patient population in the LA group (p <0.0001). Length of stay was significantly higher in the OA group (3.33 vs. 2.52) days, p <0.0001). The overall hospitalization cost of LA was 25% higher than the OA cost (p = 0.0005). The cost of an uncomplicated LA case was 1.7 times higher than in the OA group (p ≤ 0.0001). We found no statistically significant differences between the hospitalization cost of an OA and LA group when both procedures were associated with a complication (p = 0.5319). A higher complication rate was observed in the OA group, 60 cases (9.47%) as compared to the LA group, 46 cases (3.96%), p <0.0001. The increased rate of complications observed was related to cardiovascular, wound and infectious problems. CONCLUSIONS: Noncomplicated LA was associated with a higher hospitalization cost. There was no difference with regard to complicated cases. The incidence of complications increased in the OA group.

La asistencia manual es una alternativa a la conversión a laparotomía durante la sigmoidectomía laparoscópica / Hand assistance is an alternative to conversion to laparotomy during laparoscopic sigmoidectomy

Introducción En el tratamiento de la enfermedad diverticular la cirugía laparoscópica tiene diversos beneficios en comparación con la cirugía abierta. Existen 2 tipos de abordajes, el asistido por laparoscopia (LA) y el laparoscópico asistido con la mano (MA). El objetivo de este estudio es demostrar que la cirugía MA puede ser un recurso previo a la conversión a una laparotomía en caso de encontrar dificultades con el abordaje LA. Material y métodos Se realizó un estudio de cohorte retrospectivo en un hospital privado de tercer nivel en la ciudad de México. Se seleccionó a todo paciente con diagnóstico de enfermedad diverticular en el que se practicó una cirugía LA, incluidos aquellos pacientes en los que hubo dificultad técnica durante el procedimiento y se decidió continuar de manera MA. Resultados Se realizaron 47 sigmoidectomías LA, 33 de éstas se completaron de esta manera, 4 requirieron laparotomía y 10 se completaron de manera MA (de éstas ninguna requirió laparotomía). No hubo diferencia estadísticamente significativa entre los grupos laparoscópicos cuando se comparó el retorno de la función intestinal (p=0,879) y los días de estancia intrahospitalaria (p=0,679).Conclusiones La cirugía laparoscópica MA es una alternativa factible si durante una sigmoidectomía LA hay dificultad con la exposición o con la disección y evita la conversión a cirugía abierta (AU)

Introduction Laparoscopic surgery in the treatment of diverticular disease offers multiple benefits compared with its open surgery counterpart. There are two distinct techniques, the laparoscopically assisted and the laparoscopic hand assisted approach. The purpose of this study is to demonstrate that the hand assisted approach can be used if, during a laparoscopically assisted approach, there is difficulty in dissection and/or exposure, and before performing a laparotomy. Material and methods This study is a retrospective cohort series that was performed in a private tertiary hospital in Mexico City. Patients with the diagnosis of diverticular disease who underwent a laparoscopically assisted sigmoidectomy were selected. These included patients who, during their procedure required conversion to a hand assisted approach. Results A total of 47 sigmoid colectomies began with assisted laparoscopy, of which 33 were completed, 4 required laparotomy, and 10 where completed using hand assistance (none required laparotomy). There were no statistically significant differences in return of bowel function (P=0.879) and postoperative hospital stay (P=0.679) between the group that was completed by assisted laparoscopy vs. hand assisted.Conclusions If there is difficulty in exposure or dissection during a laparoscopically assisted sigmoid colectomy, the hand assisted approach is an alternative before the laparotomy (AU)

[Hand assistance is an alternative to conversion to laparotomy during laparoscopic sigmoidectomy]. / La asistencia manual es una alternativa a la conversión a laparotomía durante la sigmoidectomía laparoscópica.

INTRODUCTION: Laparoscopic surgery in the treatment of diverticular disease offers multiple benefits compared with its open surgery counterpart. There are two distinct techniques, the laparoscopically assisted and the laparoscopic hand assisted approach. The purpose of this study is to demonstrate that the hand assisted approach can be used if, during a laparoscopically assisted approach, there is difficulty in dissection and/or exposure, and before performing a laparotomy. MATERIAL AND METHODS: This study is a retrospective cohort series that was performed in a private tertiary hospital in Mexico City. Patients with the diagnosis of diverticular disease who underwent a laparoscopically assisted sigmoidectomy were selected. These included patients who, during their procedure required conversion to a hand assisted approach. RESULTS: A total of 47 sigmoid colectomies began with assisted laparoscopy, of which 33 were completed, 4 required laparotomy, and 10 where completed using hand assistance (none required laparotomy). There were no statistically significant differences in return of bowel function (P=0.879) and postoperative hospital stay (P=0.679) between the group that was completed by assisted laparoscopy vs. hand assisted. CONCLUSIONS: If there is difficulty in exposure or dissection during a laparoscopically assisted sigmoid colectomy, the hand assisted approach is an alternative before the laparotomy.