Purpose : Despite many randomized controlled trials, the merits of laparoscopic appendectomy remain unclear. Some studies suggest increased intraabdominal abscess rates following laparoscopic appendectomy, especially for perforated appendicitis. Consequently, an open approach has been advocated.
Objective: This study was designated to evaluate whether there was an advantage to laparoscopic appendectomy when compared with open appendectomy, especially complicated appendicitis.
Methods : From January 1, 2001 through December 31, 2001, 216 patients with acute appendicitis were randomized to either laparoscopic or open appendectomy. The effect sizes for operating time, hospital stay, infectious complication (wound infection, intraabdominal abscess etc) were evaluated. The complicated appendicitis were gangrenous, perforative and periappendiceal abscess. Statistical comparisions were performed using the Chi-squre test & independent T test (SPSS standard v 10.0).
Results : Ninety-five patients were assigned to the laparoscopic appendectomy group and 121 patients were assigned to the open appendectomy group. Mean age of patients were 33.45 years. Sixty-three patients (66%) in the laparoscopic appendectomy group had suppurative type, 20 patients (21%) had gangrenous type, 7 patients (7%) had perforative type, and 5 patients (5%) had periappendiceal abscess. 64 patient (53%) in the open appendectomy group had suppurative type, 27 patients (22%) had gangrenous type, 16 patients (13%) had perforative type, and 14 patients (11%) had periappendiceal abscess. There were no statistically significant differences in lenghth of operation time, postoperative infectious complications. Also no significant difference of infectious complications were seen in complicated appendicitis. But length of hospitalization in laparoscopic appendectomy group was more shorter than that of open appendectomy group (p<0.05).
Conclusion : Laparoscopic appendectomy is comparable to open appendectomy with regard to infectious complication (esp, in complicated appendicitis), operation time and hospital stay. Therefore laparoscopic appendectomy for complicated appendicitis may not be contraindicated. Authors consider that laparoscopic appendectomy may be the advisable procedure in patients with acute appendicitis, even complicated appendicitis.
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