Clinical comparative study of laparoscopy versus open surgery for appendicitis / 复旦学报（医学版）

ABSTRACT

Objective To compare and evaluate the effect of laparoscopic and traditional open surgery in the treatment of appendicitis.Methods From Jan.2013 to Oct.2016,the clinical data of 862 cases with acute appendicitis from Jinshan Hospital,Fudan University were analyzed retrospectively.Among them,335 cases were treated with laparoscopic appendectomy (LA) and 527 cases with open appendectomy (OA).The time of operation,bleeding volume,the postoperative hospital stay,hospitalization costs,incision infection,intestinal obstruction and intra-abdominal abscess were compared between the two groups.Results In LA group,325 cases had successful LA,and 10 cases turned to OA (3.0％).Compared with OA,LA was associated with reduced risk of surgical-site infection (0.9 ％ vs.4.9 ％,P＜ 0.001),less bleeding volume [(16.6 ± 13.2) mL vs.(24.7 ± 18.3) mL,P＜0.001],shorter hospital stay [(4.4 ± 1.9) d vs.(5.1 ± 2.5) d,P＜0.001],less postoperative pain (4.5％ vs.11.6％,P＜0.001).The time of operation and hospitalization costs in the LA group [(41.4 ± 8.1) min,(7 806 ± 1 406) yuan] were longer and higher than that in the OA group [(38.8 ± 11.7) min,(4 871 ± 1 308) yuan],respectively (P all＜0.001).There was no significant difference in intra-abdominal abscesses,intestinal obstruction and reoperation rate between the two groups.The total incidence of complications in LA group [9.55 ％ (32/335)] was lower than that in OA group [14.42 ％(76/527),P =0.035].LA had the advantages of minimal invasion,shorten operation time[(45.2 ±7.7) min vs.(49.0 ± 7.6) min,P =0.004],without increasing the cost [(7 951 ± 1 485) yuan vs.(7 717 ± 1 705) yuan,P =0.396],which was a more popular choice for overweight or obesity (BMI≥24) patients.Conclusions LA is a safe and reliable operational way compared with OA.It has obvious advantages in reducing the complications such as incision infection,postoperative pain and so on.While it is not completely accepted because of its higher costs and longer time of operation for the hospital.LA seems to be favored especially in patients with BMI≥24.