Advantages of laparoscopic appendectomy in the elderly

Laparoscopic appendectomy (LA) has gained in popularity in recent years. The number of elderly patients undergoing appendectomy has increased as that segment of the population has increased in number; however, the utility and benefits of LA in the elderly population are not well established. We hypothesized that LA in the elderly has distinctive advantages in perioperative outcomes over open appendectomy (OA). We queried the 1997 to 2003 North Carolina Hospital Association Patient Data System for all patients with the primary ICD-9 procedure code for OA and LA. Patients > or = 65 years of age (elderly) were identified and reviewed. Outcomes including length of stay (LOS), charges, complications, discharge location, and mortality were compared between the groups. There were 29,244 appendectomies performed in adult patients (>18 years old) with 2,722 of these in the elderly. The annual percentage of LA performed in the elderly increased from 1997 to 2003 (11.9-26.9%, P < 0.0001). When compared with OA, elderly patients undergoing LA had a shorter LOS (4.6 vs 7.3 days, P = 0.0001), a higher rate of discharge to home (91.4 vs 78.9%, P = 0.0001) as opposed to a step-down facility, fewer complications (13.0 vs 22.4%, P = 0.0001), and a lower mortality rate (0.4 vs 2.1%, P = 0.007). When LA was compared with OA in elderly patients with perforated appendicitis, LA resulted in a shorter LOS (6.8 vs 9.0 days, P = 0.0001), a higher rate of discharge to home (86.6 vs 70.9%, P = 0.0001), but equivalent total charges (dollars 22,334 vs dollars 23,855, P = 0.93) and mortality (1.0 vs 2.98%, P = 0.10). When elderly patients that underwent LA were compared with adult patients (18-64 years old), they had higher total charges (dollars 16,670 vs dollars 11,160, P = 0.0001) but equivalent mortality (0.37 vs 0.15%, P = 0.20). The use of laparoscopy in the elderly has significantly increased in recent years. In general, the safety and efficacy of LA is demonstrated by a reduction in mortality, complications, and LOS when compared with OA. The laparoscopic approach to the perforated appendix in the elderly patient has advantages over OA in terms of decreased LOS and a higher rate of discharge to home as opposed to rehabilitation centers, nursing homes, or skilled nursing care. When compared with all younger adults, the laparoscopic approach in the elderly was associated with equal mortality rates even though hospitalization charges were higher. Laparoscopy may be the preferred approach in elderly patients who require appendectomy.     

Laparoscopic appendectomy significantly reduces length of stay for perforated appendicitis

Introduction Though ruptured appendicitis is not a contraindication to laparoscopic appendectomy (LA), most surgeons have not embraced LA as the first-line approach to ruptured appendicitis. In fact, in 2002, the Cochrane Database Review concluded: 1) the clinical effects of LA are “small and of limited clinical relevance,” and 2) the effects of LA in perforated appendicitis require further study. Objective To study the effects of LA vs open appendectomy (OA) among adults with appendicitis. Methods In 2003, 272 adults underwent appendectomy at a large County hospital, and were enrolled in a prospective clinical pathway that detailed their hospital course from time of diagnosis to discharge. Data included patient demographics, time elapse from diagnosis to surgery, surgical technique (LA vs. OA), operative diagnosis (acute vs perforated appendicitis) and post-operative length of stay (LOS). Results Complete data was obtained for 264 (97%) patients. Patient demographics were similar in the LA and OA groups (p > 0.05). Patients with LA had a significantly shorter LOS than OA by 1.6 days (p < 0.05). This LOS was significantly shorter among those with ruptured appendicitis vs. non-ruptured appendicitis (2.0 days vs. 0.3 day reduction, p = 0.0357). Rank-order multiple regression analysis, controlling for all other factors, showed laparoscopy to have a significant effect on postoperative LOS in all appendicitis cases, especially ruptured appendicitis. Conclusions The two-day reduction in LOS among those with ruptured appendicitis who underwent LA was significant enough to overcome the smaller benefit of LA in acute appendicitis. From a hospital utilization point of view, LA should be considered as the first-line approach for all patients with appendicitis.     

Comparison of laparoscopic versus open appendectomy for acute nonperforated and perforated appendicitis in the obese population

Background

Use of laparoscopic appendectomy (LA) has been increasing in obese patients. We evaluated the outcomes of LA compared with open appendectomy (OA) in obese patients.

Methods

By using the Nationwide Inpatient Sample database, clinical data of obese patients who underwent LA and OA for suspected acute appendicitis (perforated or nonperforated) from 2006 to 2008 were examined.

Results

A total of 42,426 obese patients underwent an appendectomy during this period. In acute nonperforated cases, LA had a lower overall complication rate (7.17% vs 11.72%; P < .01), mortality rate (.09% vs .23%; P < .01), mean hospital charges ($25,193 vs $26,380; P = .04), and shorter mean length of stay (2.0 vs 3.1 d; P < .01) compared with OA. Similarly, in perforated cases, LA was associated with a lower overall complication rate (22.34% vs 34.65%; P < .01), mortality rate (.0% vs .50%; P < .01), mean hospital charges ($36,843 vs $43,901; P < .01), and a shorter mean length of stay (4.4 vs 6.5 d; P < .01) compared with OA.

Conclusions

LA can be performed safely with superior outcomes compared with OA in obese patients and should be considered the procedure of choice for perforated and nonperforated appendicitis in these patients.     

Laparoscopic appendectomy in children after the learning curve.

OBJECTIVES: Despite its increasing popularity, several recent studies comparing laparoscopic appendectomy (LA) with open appendectomy (OA) in children have failed to demonstrate significant improvements in patient outcomes. Many series include the "learning curve," wherein surgeons inexperienced with laparoscopic techniques compare their results with results with OA with its extensive history. This study was designed to investigate outcomes in pediatric appendectomy patients managed by surgeons with extensive laparoscopic experience. METHODS: We preformed a retrospective review of 197 consecutive children undergoing appendectomy for presumed acute appendicitis from January 2002 through May 2004 at a university-affiliated community hospital by pediatric and general surgeons with extensive laparoscopic surgical experience. RESULTS: The study included 117 patients who underwent LA and 80 who underwent OA. Of 122 acute appendicitis cases, mean operating times were 47 minutes (LA) and 48 minutes (OA). The LA group (n=71) had a faster return to full diet (17.6 h vs. 28.6 h, P=0.0008), and shorter postoperative length of stay (LOS) (1.06 d vs. 1.66 d, P<0.0001) compared with the OA group (n = 51). Complication rates, time on intravenous (IV) antibiotics, and IV opiates were similar among the 2 groups. Complicated appendicitis cases (LA, n=34; OA, n=26) were similar with regard to LOS, return to normal bowel function, complication rate and time on IV antibiotics and opiates, but was associated with an increased operation time (LA, 65 min; OA, 51 min, P=0.02). CONCLUSIONS: Following the completion of the laparoscopic surgery learning curve, LA has a comparable operation time and results in a decreased postoperative LOS, and faster return to normal bowel function compared with OA in children with acute nongangrenous, nonperforated appendicitis.     

Outcome of laparoscopic appendectomy for perforated appendicitis in children

Background

The aim of this study was to evaluate the outcome of laparoscopic (LA) vs open appendectomy (OA) in patients with perforated appendicitis in our center.

Methods

Retrospective review from July 2002 to April 2007 (institutional review board-approved), evaluating 281 patients with perforated appendicitis based on surgical approach. We compared demographics, mean operative time, length of stay (LOS), infectious complications, and follow-up in patients with OA (n = 213) and LA (n = 68).

Results

Laparoscopic appendectomy patients were significantly older (12 vs 9.4 years), heavier (51.8 vs 36.6 kg) and more frequently girls (47.8% vs 34.3%). Mean operative time was longer in LA (72.6 vs 50.2 minutes). Median LOS was 5 days in LA and 6 days in OA. Few patients in each group required a drainage procedure for a persistent abscess (LA 4.4%, OA 4.7%; P = 1.000). Laparoscopic appendectomy patients had fewer wound infections (1.5% vs 9.5%; P = .034), and less follow-up visits were needed (>2 clinic visits 4.5% vs 16.4%; P = .013).

Conclusion

Laparoscopic appendectomy has a shorter median LOS, a trend toward less postoperative infectious complications, and fewer clinic visits than OA, which makes it a safe and effective procedure for patients with perforated appendicitis.     

Complicated appendicitis--is the laparoscopic approach appropriate? A comparative study with the open approach: outcome in a community hospital setting

Good outcome has been reported with the laparoscopic approach in uncomplicated appendicitis, but a higher incidence of postoperative intraabdominal abscesses has been reported after laparoscopic appendectomy in complicated appendicitis. This retrospective comparative study compares outcome after laparoscopic (LA) and open appendectomy (OA) in complicated appendicitis. All patients who had LA or OA for complicated appendicitis between January 2003 and February 2006 were included in the study. Data collection included demographics, operative time, estimated blood loss, length of stay (LOS), complications, readmission, and reoperative rates. The primary end points for analysis were postoperative intraabdominal abscess and complication rates and secondary end points were LOS and operative time. All data were analyzed on an intent-to-treat basis. Of 104 patients, 43 patients underwent LA and 61 had OA. The mean age (24.8 +/- 16.5 versus 31.3 +/- 18.9, P = 0.08) in the LA group was lower than the OA group because there was a significantly higher proportion of pediatric patients (34.8% versus 14.8%, P = 0.02) who had LA. There was no significant difference in gender (female/male, 14/29 versus 27/34, P = 0.3) or American Society of Anesthesiologists class distribution (American Society of Anesthesiologists 1/2/3/4/, 35/7/1/0 versus 45/12/3/1, P = 0.68) between the two groups. The operative time (100.5 +/- 36.2 versus 81.5 +/- 29.5 minutes, P = 0.03) was significantly longer and the estimated blood loss (21 mL versus 33 mL, P = 0.01) was lower in LA when compared with OA, but there was no significant difference in the number of patients with preoperative peritonitis versus abscesses (7/36 versus 13/48, P = 0.6) in both groups. There was no difference in the median LOS (6 [interquartile range 5-9] versus 6 [interquartile range 4-8], P = 0.7) in the two groups. The conversion rate in LA was 18.6% (n = 8). There was also no significant difference in the complication (17/43 [39.5%] versus 21/61 [34.4%], P = 0.54), reoperative (3/43 [7%] versus 0/61 [0%], P = 0.07), and 30-day readmission (5/41 [11.6%] versus 3/61 [4.9%], P = 0.23) rates between the two groups. The rate of postoperative intraabdominal abscesses was significantly higher in the LA group when compared with the OA group (6/43 [14%] versus 0/61 [0%], P = 0.04) and the wound infection (1/43 [2.3%] versus 5/61 [8.2%], P = 0.4) and pulmonary complication (0/43 [0%] versus 3/61 [4.9%], P = 0.26) rate was higher in the OA group. There was no mortality in the LA group, but there was one mortality in the OA group resulting from postoperative myocardial infarction. Laparoscopic appendectomy can be performed in patients with complicated appendicitis with a comparative operative time, LOS, and complication rates but results in a significantly higher intraabdominal abscess rate and lower wound infection rate when compared with OA.     

The benefits of laparoscopic appendectomies in obese patients

BackgroundSystematic reviews and randomized controlled trials comparing laparoscopic appendectomy (LA) with open appendectomy (OA) show a reduction in wound infections associated with LA but a 3-fold increase in intra-abdominal abscess with LA. Surgical time and operation costs are higher with LA. The advantage of LA over OA is small. Although these patients have not been specifically analyzed in the report, the systematic review recommends the routine use of LA in young women and obese people. The purpose of this study is to determine if obese patients benefit in a shorter length of stay (LOS) by having LA versus OA surgery compared with their nonobese counterparts.MethodsA retrospective chart review of 315 adult patients who have undergone appendectomies at Royal Columbian and Burnaby Hospitals between April 1, 2010 and March 31, 2011. Appendectomies performed in pregnant women combined with other surgeries and those converted to OA were excluded. Outcomes and the postoperative stay for obese and nonobese patients were assessed.ResultsThe LOS is shorter with LAs than with OAs (2.06 vs 4.13 days, P < .05). The LOS, in obese patients, is much shorter with LAs than with OAs (1.69 vs 6.82 days, P < .05). The variability in LOS is much higher in obese patients as compared with nonobese patients (standard deviation = 8.57 vs 2.67). The body mass index and the type of surgery contribute to a significant difference in LOS.ConclusionsObese patients who undergo LA have a decreased LOS as compared with obese patients who undergo OA for appendicitis. This is the first study showing specifically that LA benefits obese patients and the health care system.     

Value of Laparoscopic Appendectomy in Perforated Appendicitis

Background The purpose of this clinical study was to evaluate the efficacy of laparoscopic appendectomy in patients with perforated appendicitis. Methods This study involved a total of 73 consecutive patients who had undergone appendectomy for perforated appendicitis between January 1999 and December 2004. While 39 patients underwent open appendectomy (OA) during the first 3 years, the remaining 34 patients underwent laparoscopic appendectomy (LA) during the last 3 years. Results There was no case of LA converted to OA. No significant difference was found in the operating time between the two groups. Laparoscopic appendectomy was associated with less analgesic use, earlier oral intake restart (LA, 2.6 days; OA, 5.1 days), shorter median hospital stay (LA, 11.7 days; OA, 25.8 days), and lower rate of wound infections (LA, 8.8%; OA, 43.6%). Conclusions These results suggest that LA for perforated appendicitis is a safe procedure that may prove to have significant clinical advantages over conventional surgery.     

Laparoscopic appendectomy in the elderly

BACKGROUND: Evidence suggests that laparoscopic appendectomy (LA) has advantages over open appendectomy (OA) in the treatment of appendicitis. It remains, however, unclear whether LA is indicated in the elderly patient population. METHODS: Patients with primary International Classification of Diseases, revision 9, procedure codes for LA (n=32406 patients) and OA (n=112884 patients) were selected from the 1998, 1999, and 2000 Nationwide Inpatient Samples. The end points that were under investigation were the length of hospital stay, the rate of routine discharge, and in-hospital morbidity and mortality rates. Multiple linear and logistic regression analyses were performed to assess the risk-adjusted association between the surgery type and the patient outcomes. Stratified analyses were performed according to age (65 years and older; less than 65 years old) and to the presence of appendiceal perforation or abscess. RESULTS: After risk adjustment, patients who underwent LA had a significantly shorter mean length of stay (LA, 2.45 days; OA, 3.71 days; P <. 0001), higher rate of routine discharge (odds ratio, 2.80; P <.0001), lower overall complication rate (odds ratio, 0.92; P=.03), and mortality rate (odds ratio, 0.23; P=.001) compared with OA patients. Similar benefits of LA were found in the strata of patients who were less than 65 years old, in elderly patients, and in patients with appendiceal perforation or abscess. CONCLUSION: LA has statistically significant advantages over OA with respect to the length of hospital stay, the rate of routine discharge, and postoperative morbidity and mortality rates for patients who are less than 65 years old, in elderly patients, and in patients with appendiceal abscess or perforation.     

腹腔镜与开腹阑尾切除术治疗急性阑尾炎的疗效分析

目的 比较腹腔镜阑尾切除术(laparoscopic appendectomy,LA)和开腹阑尾切除术(open appendectomy,OA)治疗急性阑尾炎的结果.方法 将2005年5月至2010年5月收治的396例行阑尾切除术的急性阑尾炎病人按手术方法分为LA组和OA组,比较分析两组病人的临床资料.结果 LA组与...     

Laparoscopic versus open appendectomy: is the postoperative infectious complication rate different?

Despite the reported advantages of laparoscopic appendectomy (LA), there is debate about the postoperative infectious complication rate. Our study attempts to determine if the infectious complication rate between LA and open appendectomy (OA) is different. A retrospective review was conducted of all patients who underwent appendectomy at Kern Medical Center between 1999 and 2003. Age, sex, white blood cell count, temperature, pathology, and postoperative complications were identified. Fifty-seven patients underwent LA, and 159 patients underwent OA. The groups were well matched for demographics, white blood cell count, temperature, and percent perforated appendicitis. There was an overall 9.3 per cent complication rate. The infectious complication rate in OA versus LA group was statistically different (6.3% vs 17.6%, P = 0.04). The infectious complication rate in the LA group was significantly higher than in the OA group. Further large randomized trials are necessary to confirm our findings and to identify if LA is appropriate for a subset of appendicitis patients.     

Laparoscopic approach in perforated appendicitis: increased incidence of surgical site infection?

Background

The role of laparoscopy in the setting of perforated appendicitis remains controversial. A retrospective study was conducted to evaluate the early postoperative outcomes of laparoscopic appendectomy (LA) compared to open appendectomy (OA) in patients with perforated appendicitis.

Methods

A total of 1,032 patients required an appendectomy between January 2005 and December 2009. Among these patients, 169 presented with perforated appendicitis. Operation times, length of hospital stay, overall complication rates within 30 days, and surgical site infection (SSI) rates were analyzed.

Results

Out of the 169 evaluated patients, 106 required LA and 63 OA. Although operation times were similar in both groups (92 ± 31 min for LA vs. 98 ± 45 for OA, p = 0.338), length of hospital stay was shorter in the LA group (6.9 ± 3.8 days vs. 11.5 ± 9.2, p < 0.001). Overall complication rates were significantly lower in the LA group (32.1 vs. 52.4 %, p < 0.001), as were incisional SSI (1.9 vs. 22.2 %, p < 0.001). Organ/space SSI rates were similar in both groups (23.6 % after LA vs. 20.6 % after OA, p = 0.657).

Conclusions

For perforated appendicitis, LA results in a significantly shorter hospital stay, fewer overall postoperative complications, and fewer wound infections compared to OA. Organ/space SSI rates were similar for both procedures. LA provides a safe option for treating patients with perforated appendicitis.     

Laparoscopic appendectomy versus open appendectomy in children: another opinion

Laparoscopic appendectomy (LA) is a commonly performed procedure that is a safe alternative to conventional open appendectomy (OA). LA offers reduced parietal scarring, a shortened hospital stay, and an earlier return to normal activities. During a 13-month period (July 2001 to July 2002), data were collected regarding appendectomies performed in 113 children (<18 years) in our hospital. Patients were divided into two groups according to type of appendectomy received (OA, N = 59 versus LA, N = 54). The operative time, length of hospital stay, and postoperative complications were compared between the two groups. Operative time was similar in the OA and LA groups (1.20 +/- 0.46 versus 1.12 +/- 0.36 hours, respectively; P = 0.328). Patients receiving OA had significantly longer hospital stays than those receiving LA (4.69 +/- 3.45 versus 3.07 +/- 1.93 days, respectively; P = 0.002). The complication rate associated with OA was higher than that observed for LA (6.8% versus 3.5%), but this difference was not significant (P = 0.681). Patients receiving LA could begin drinking water earlier after surgery than postflatus OA patients (12-24 hours versus 3.2 days). The OA group had a higher rate of ruptured appendicitis than the LA group (13/59 versus 2/54), but similar rates of normal appendix was observed in both groups (13/59 versus 13/54). Three patients in the LA group were switched to OA. Although patients who underwent LA did not experience a significant decrease in complications compared with OA patients, they did have shorter hospital stays and postoperative NPO times. Therefore, LA seems to be a safe operation in children. It is ideal for overweight, adolescent females and patients in whom appendicitis is suspected. LA is not recommended for those with an appendiceal mass.     

Laparoscopic versus open appendectomy for complicated appendicitis

BACKGROUND: Laparoscopic appendectomy has been widely practiced for uncomplicated appendicitis; various reports demonstrated its merits in assisting diagnosis, reducing postoperative pain, analgesic requirement, and incidence of wound infection. The role of laparoscopy in management of complicated appendicitis, ie, gangrenous, perforated appendicitis and appendiceal abscess, remains undefined. Currently, the choice of operative approach is mostly at the surgeons' discretion. A retrospective study was conducted in our institution to review the feasibility, safety, and efficacy of laparoscopic appendectomy for patients with complicated appendicitis. STUDY DESIGN: From January 1999 to January 2004, records of patients older than 14 years of age with diagnosis of appendicitis were retrieved from computer database for analysis. All patients underwent diagnostic laparoscopy to confirm diagnosis of complicated appendicitis, and patients subsequently underwent either laparoscopic or open appendectomies. Patients' demographics data and perioperative outcomes from the two groups were compared. RESULTS: During the study period, 1,133 patients with acute appendicitis underwent operations in our institution. Two hundred forty-four patients (21.5%) with complicated appendicitis were identified by laparoscopy, of which 175 underwent laparoscopic appendectomy (LA) and 69 had open appendectomy (OA). Both groups of patients were comparable in demographics. Mean operative time was 55 minutes for LA group and 70 minutes for the OA group (p<0.001). Mean hospital stay was 5 days and 6 days for LA and OA group respectively (p<0.001). There was one conversion patient (0.6%) in the LA group who suffered from wound infection, and there were seven (10%) wound infections in the OA group (p=0.001). There were 10 cases (5.7%) of intraabdominal collection in the LA group and 3 (4.3%) in the OA group (p=0.473). There was no mortality in the current series. CONCLUSIONS: Laparoscopic appendectomy for complicated appendicitis is feasible and safe. It is associated with a significantly shorter operative time, lower incidence of wound infection, and reduced length of hospital stay when compared with patients who had open appendectomy.     

Laparoscopic versus open appendectomy for perforated appendicitis

The role of laparoscopic appendectomy (LA) for perforated appendicitis is under investigation. A retrospective study was conducted to compare the outcomes of laparoscopic versus open appendectomy (OA) for perforated appendicitis. From January 2001 through December 2003, 229 patients with perforated appendicitis were treated at Far-Eastern Memorial Hospital. LA was successfully completed in 91 of 99 patients. OA was performed in 130 patients. Operation time was longer in the LA group (mean ± SD =96.1±43.1 vs. 67.8±32.2 minutes, P<0.01). Return of oral intake was faster in the LA group (3.2±2.4 vs. 5.0±7.0 days, P<0.01). The intravenous antibiotic usage period was shorter in the LA group (4.4±2.8 vs. 6.3±7.1 days, P<0.01). The postoperative wound infection rates were 15.2 % (LA group) and 30.7% (OA group). The overall infectious complication rates were 19% in the LA group and 37% in the OA group (P<0.01). Hospital stay days were shorter for the LA group (6.3±2.9 vs. 9.3±8.6 days, P<0.01). Our results indicated that laparoscopic appendectomy is a safe and effective procedure for treating patients with perforated appendicitis.     

Outcomes of laparoscopic versus open appendectomy

Controversy remains regarding which approach is better, laparoscopic appendectomy (LA) or open appendectomy (OA). A 5-year retrospective review of patients undergoing appendectomy was performed to compare the outcomes of LA and OA using standard statistical methods (P < 0.05). LA was performed in 207 and OA in 100 patients (conversion 6.7%). Females underwent LA more frequently than males (81.7% vs 51.9%; P = 0.0001). LA patients were older (30.2 years vs 25.7 years; P = 0.03), with no differences in body mass index (BMI) (27.9 kg/m2 vs 25.5 kg/m2; P = 0.06) or operative times (51.1 minutes vs 51.5 minutes; P = 0.84). LA patients required less analgesics (19.2 mg vs 31.5 mg; P = 0.01), and shorter hospital stays (27.2 hours vs 53.1 hours; P = 0.0001). Operating room charges were higher for LA (3839 dollars vs 2528 dollars; P = 0.0001), with no difference in total hospital charges (8801 dollars vs 9147 dollars; P = 0.14). Complications between LA and OA were similar (3.6% vs 8%; P = 0.12). Converted patients were older, required more analgesia, and had higher morbidity, length of stay, and hospital charges. LA is the procedure of choice for appendicitis regardless of age, sex, BMI, or degree of appendiceal inflammation. LA is as safe and quick to perform as OA with lower analgesic requirements, length of stay, and no difference in total charges.     

Laparoscopic appendectomy for simple and perforated appendicitis in children: the procedure of choice?

BACKGROUND/PURPOSE: Whether laparoscopic appendectomy (LA) is superior to open appendectomy (OA) for simple (SA) and perforated appendicitis (PA) in children is debatable. The operative experience of 4 senior pediatric surgeons at a single institution was studied over a 6-year period during a transition from OA in all cases to LA in all cases, to answer this question. METHODS: All appendectomies from December 1993 to December 1999 were reviewed for operative technique (OA, LA), presence of perforation (SA, PA), operating time (OT), length of stay (LOS), morbidity, and mortality. RESULTS: There were 1,128 appendectomies in children aged 14 months to 19 years, including 955 LA (653 in SA, 302 in PA) and 173 OA (86 in SA, 87 in PA). OT was equal for LA and OA in SA (52 minutes), but has dropped to less than 40 minutes for LA in the past year. OT in PA was slightly longer in LA versus OA (68 v. 58 minutes; P < .001) but recently has dropped in LA to less than 60 minutes. LOS in SA was 2 days for LA and 3 days for OA; in PA, LOS was 7 days in both LA and OA, but has dropped to 5 days for LA recently. Postoperative abscess rates and incidence of bowel obstruction did not differ between LA and OA in either group. There was no mortality. CONCLUSIONS: LA is at least as safe and effective as, if not superior to, OA for both simple and perforated appendicitis. Postoperative pain is less, and recovery is faster, thereby reducing LOS and overall cost. The growing demand for this procedure can be satisfied without increase in cost, morbidity, or mortality. Laparoscopic appendectomy is our procedure of choice in children.     

腹腔镜复杂性阑尾切除术的体会

目的:探讨腹腔镜在复杂性阑尾切除术中的应用价值。方法:回顾分析1999～2009年施行907例复杂性阑尾切除术的临床资料,其中482例行腹腔镜阑尾切除术(laparoscopic appendectomy,LA),425例行传统开腹阑尾切除术(open ap-pendectomy,OA),对比分析两组手术情况及手术效果。结果:OA组在手术时间、住院费用方面优于LA组,但差异无统计学意义(P>0.05);在肛门恢复排气时间、住院时间、术后切口感染率、术后腹腔内残余脓肿发生率及术后粘连性肠梗阻发生率方面LA组优于OA组,差异有统计学意义(P<0.05);LA组术后肠梗阻形成时间优于OA组,但差异无统计学意义(P>0.05)。结论:与传统开腹阑尾切除术相比,LA在复杂性阑尾切除术中具有明显优势,具有术后肛门排气快、住院时间短、术后感染性并发症发生率低等优点,且并不明显增加住院费用及手术时间,可作为处理复杂阑尾炎时的首选术式。     

A comparative study of routine laparoscopic versus open appendectomy.

OBJECTIVE: We evaluated the outcomes of routine laparoscopy and laparoscopic appendectomy (LA) in patients with suspected appendicitis. This is a retrospective study of the outcomes of patients undergoing laparoscopic appendectomy compared with outcomes for patients undergoing open appendectomy (OA) during the time that LA came into use. METHOD: Results of patients managed with routine laparoscopy and LA for suspected acute appendicitis were reviewed and analyzed. The preoperative and intraoperative findings were recorded. The clinical outcomes were compared with those of patients undergoing OA in the preceding 10 months. RESULTS: During the LA study period, 97 patients (47 men) with the median age of 34 years (range, 18 to 79) presented with clinical features of acute appendicitis. With the exclusion of 5 patients with open operations and 10 patients with other pathologies, 82 patients underwent laparoscopic appendectomy (Group A) for appendicitis. Thirty-one (37.8%) patients had complicated appendicitis (perforated or gangrenous appendicitis). Conversions were required in 6 patients (7.3%). During the OA period, 125 patients (57 men) with the median age of 42 (range, 19 to 79) years were operated on. With the exclusion of 6 patients with other pathologies, 119 underwent OA for acute appendicitis (Group B). Fifty-one (42.9%) had either perforated or gangrenous appendicitis. The median durations of surgery in Group A and Group B were 80 minutes (range, 40 to 195) and 60 minutes (range, 25 to 260), respectively (P < 0.005). Postoperative complication rates were comparable between the 2 groups (13.4% in Group A versus 15.8% in Group B). The median hospital stay for patients in Group A and Group B were 3.0 days (range, 1 to 47) and 4.0 days (range, 1 to 47), respectively (P = 0.037). CONCLUSIONS: We conclude that routine laparoscopy and LA for suspected acute appendicitis is safe and is associated with a significantly shorter hospital stay. Other intra-abdominal pathologies can also be diagnosed more accurately with the laparoscopic approach.     

Laparoscopic appendectomy is superior to open appendectomy in obese patients

BACKGROUND: There are minimal data comparing laparoscopic appendectomy (LA) with open appendectomy (OA) in obese patients. METHODS: We reviewed consecutive adult patients from 2003 to 2005 who underwent an appendectomy at a University-affiliated teaching hospital. Obesity was defined as a body mass index of 30 or greater. Outcome measures included length of stay, surgical times, intra-abdominal abscesses, wound infections, and hospital charges. RESULTS: There were 116 patients with a mean body mass index of 35. Eighty-five patients underwent LA, 12 were converted to open, 4 of 12 (31%) were perforated. Thirty-one patients underwent OA. Overall, 21 (18%) were perforated. Length of stay for LA was better, 3.4 days versus 5.5 days for OA (P = .02), and wound closure rate was better, 90% for LA versus 68% for OA (P < .01). Other outcome measures were equivalent. CONCLUSIONS: LA is associated with shorter lengths of stay, fewer open wounds, and equivalent hospital charges and intra-abdominal abscess rates; and should be considered the procedure of choice for obese patients with appendicitis.