Many authors have evaluated laparoscopic appendectomy(LA) and found it to be a useful method of treatment for acute appendicitis. It can reduce postoperative complication as well as hospital stay. In Korea, medical insurance does not cover
surgery
using
laparoscopic instruments. Many patients and surgeons suggest that laparoscopic surgery is too expersive. We evaluated the usefulness of LA as a comparative study with LA(N=53) and OA (open appendectomy N=113), conducted at Inha Hospital between
July
1994 and May 1995.
There's no significant difference in the demographic findings, symptoms and signs, and laboratory findings between. LA and OA patients. The net operative time was similar between the two groups(OA=49.3±16.8 min ; OA=47.2±20.5 min), but the
anesthesia
time of LA(71.2±18.2 min) was longer than that of OA(61.5±21.0min(p<0.05). The patients of OA complained of more pain than LA patients. The LA patients recovered more rapidly to normal somatic functions as ambulation, flatus and diet. LA
patients
stayed in the hospital for a shorter period of time (LA=4.6±2.4 days; OA=7.0±1.9 days) The LA patients refurned to their regular daily routine sooner(15.7±3.2 days) than the OA patients(36.9±9.1 days)(p<0.05). With respect to post-operative
complications, there were no significant differences, although the wound infection rate of LA(5.7%) was lower than that of OA(18.6%).
The total amount of hospital cost was not different from each groups(LA=895,597.8±261,372.2 Won; OA=849,258.6±259,192.5 Won). LA made the patient pay a heavy actual cost because it was not covered by medical insurance(LA=356,928.2±121,913.6
won;
OA=217,073.7±70,120.9 won) (p<0.05). The difference resulted from the costs of surgical supplies (instruments). LA has not been used widely because of the idea that it is too expensiveness, despite its clinical superiority.
Also there's a limit to the wide use of LA because of medical insurance system in Korea. But patients of LA returned to work earlier than OA patients, so the economic problem to the patient would be counterbalanced. Therefore, there's a need to
change
the current concept of expensiveness of LA with education, and to reform the irrational application of insurance.
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