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Laparoscopic Versus Standard Appendectomy Outcomes and Cost Comparisons in the Private Sector of a Developing Country: Better Operation for the Patients, Surgeons, Payers or Endosurgery Industries?
Claudio J. Bresciani, University of Sao Paulo, Sao Paulo, SP; Rodrigo O. Perez, University of Sao Paulo Surgery of the Alimentary Tract Division, Sao Paulo, s, Brazil; Alberto Ozaki, Carlos E. Jacob, University of Sao Paulo Surgery of the Alimentary Tract Division, Sao Paulo, SP, Brazil; Renato Iwashita, Angelita Habr-Gama, University of Sao Paulo Surgery of the Alimentary Tract Division, Sao Paulo, s, Brazil; Joaquim Gama-Rodrigues, University of Sao Paulo Surgery of the Alimentary Tract Division, Sao Paulo, SP, Brazil

Purpose:
Since the development of minimally invasive surgery there has been great interest in its application to the operation of the digestive system. This interest was initially driven by the possibility of minimal surgical trauma in operations without laparotomy leading in significant shorter hospital stay, less associated pain, shorter return to normal activities and improved cosmetics. However, these advantages may not be observed in all operations of the gastrointestinal tract.

In this setting we compared the results of patients with acute appendicitis treated by laparoscopic versus standard surgery by the same surgical team in two different private hospitals.

Patients and Methods:
148 patients with clinical and radiological diagnosis of acute appendicitis treated in 2 different hospitals were retrospectively reviewed. 78 patients were treated in hospital A (Laparoscopy) and 70 patients were treated in hospital B (standard)by the same surgical team. Patients (Groups A and B) were compared in terms of clinical and pathological features, operation characteristics, complications and costs.

Results:
There were no significant differences between both groups in terms of gender distribution, duration of symptoms, leukocyte count, radiological (USG and CT findings), occurrence of postoperative fever, complication, hospital readmission and reoperation rates and dosis of analgesic medications (opioid and non-opioid) or final pathological report diagnosis (p>0.05).Overall and OR costswere signifcantly higher in patients treated by laparoscopy.

Conclusions:
Laparoscopic versus standard approach for acute appendicitis in our series led to subtle differences in terms of hospital stay and recovery of bowel movements favoring patients treated by laparoscopy. Together with the better cosmetic results with laparoscopy these advantages should be carefully examined in the setting of acute appendicitis. In turn, overall and OR related costs were significantly higher for this same group of patients. The surgeon must consider these issues when choosing between both procedures.


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