Should appendectomy be performed laparoscopically? Clinical prospective randomized trial
Barış Mantoğlu1, Bora Karip2, Metin Mestan3, Yalın Işcan2, Birol Ağca2, Hasan Altun2, Kemal Memişoğlu2
Keywords: Acute appendicitis, laparoscopic appendectomy, open appendectomy
Objective: Laparoscopic appendectomy (LA) has been described in 1983, and its superiority over open appendectomy (OA) is still being debated. Currently, there is no agreement on the advantages of LA. Postoperative pain is reported to be lower along with a faster return to normal activities in LA. However, some studies do not support these findings. In our study, we aimed to compare the outcomes and cost effectiveness of LA and OA.
Material and Methods: Patients were prospectively randomized into LA (31 patients) and OA (32 patients) groups. Demographic data, pre- and postoperative C-reactive protein (CRP) levels, white blood cell (WBC) count, duration of surgery and hospitalization, complications, and pain scores (VAS) were recorded. Cost was calculated for both groups. Return to normal activities was evaluated by phone calls at the first, second week and 1 month after surgery.
Results: There was a significant postoperative decrease in WBC count in the LA group (p<0.01). There were no differences between LA and OA groups in terms of postoperative CRP levels (p>0.05). The rates of wound infection and abscess were similar (p>0.05), while post-operative pain and time to return to normal activities were higher in the OA group (p<0.01). There was a positive correlation between BMI and operative time in the LA group (p<0.01), while BMI and operative time did not show a correlation in the OA group (p>0,05). The average cost in the LA and OA groups were 1960.5±339.05 and 687.115±159.5 TL, respectively.
Conclusion: LA is an effective method in the treatment of acute appendicitis due to less pain and faster recovery. LA can be the choice of treatment in acute appendicitis, with utilization of re-useable and cheaper vascular sealing devices.
Ethics committee approval was received for this study from the ethics committee of Istanbul Fatih Sultan Mehmet Training and Research Hospital.
Written informed consent was obtained from patients who participated in this study.
Concept - K.M., H.A.; Design - B.M., B.K.; Supervision - Y.İ., B.A.; Funding - K.M., B.K.; Materials - M.M., B.M.; Data Collection and/or Processing - B.M., B.K.; Analysis and/or Interpretation - K.M., B.K.; Literature Review - H.A., B.K.; Writer - B.A., B.K.; Critical Review - B.A., K.M.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.