Abstracts
1997 Digestive Disease Week

Prospective randomized comparison of laparoscopic and open appendectomy.

MP Bannon, SP Zietlow, WS Harmsen, MG Sarr, CD Smith, DM Ilstrup, Y Baerga-Varela, AL Beal, RM Devine, JH Donohue, DR Farley, MB Farnell, CS Grant, H Nelson, FG Que, GB Thompson. Mayo Clinic, Rochester, MN.

PURPOSE: To compare clinical outcomes following laparoscopic and open appendectomy. METHODS: Patients presenting with acute appendicitis were randomized to laparoscopic or open appendectomy. Perioperative antibiotic, analgesic, and dietary orders were identical for both groups. Appropriate sample size (n = 100 per group) was calculated before the study began based on pre-study hospital length of stay data. With an alpha of 0.05, the power of study to detect a 1.3 day difference in hospital stay between groups was 80%. Quantitative variables expressed as means were compared with Wilcoxon's rank sum test; qualitative variables were compared with a chi-square or Fisher's exact test. RESULTS: 93 evaluable patients were randomized to the laparoscopic group and 105 to the open group. No differences between groups occurred in severity of symptoms, negative appendectomy rate (16%), or in frequency of perforated or gangrenous appendicitis. Laparoscopic appendectomy was converted to open appendectomy in 15 patients (16%) who were retained in the laparoscopic group for analysis. Follow-up averaged 348 days. Duration of operation was longer for the laparoscopic group, 111 versus 96 minutes, p < 0.01 while postoperative hospital stay was slightly but significantly shorter, 3.6 versus 4.4 days, p < 0.01. More patients used no postoperative parenteral analgesics in the laparoscopic group, 20 (22%) versus 3 (3%), p < 0.01. There were no differences in wound infection or other complications between groups. Return to full activity was shorter in the laparoscopic group, 19 days versus 24 days, p < 0.05, but no difference occurred in return to work. Subgroup analysis suggested that laparoscopic appendectomy was associated with a) earlier return to work for laborers; b) earlier return to full activity for physically active patients; and c) no advantage for complicated appendicitis. CONCLUSION: Laparoscopic appendectomy is safe, but the statistical advantages it offers over open appendectomy are of questionable clinical significance. Laparoscopic appendectomy may be advantageous for active patients with uncomplicated appendicitis.