Comparison of open and laparoscopic treatment of acute appendicitis (Retrospective study about 300 appendectomies)

Background: Appendectomy can be performed using either a laparoscopic or an open technique. This study compares the outcome of patients treated for acute appendicitis by open appendectomy with the outcome of those undergoing laparoscopic appendectomy. Methods: Patients undergoing appendectomy at The Regional Hospital of Zaghouan between March 2002 and December 2004 were studied. Outcome of patients having open appendectomy was compared with that of patients having laparoscopic appendectomy. Results: Three hundred patients underwent appendectomy for acute appendicitis during the 33- month study period. One hundred eighty (60%) had open appendectomy and 120 (40%) had laparoscopic appendectomy. Forty percent of laparoscopic appendectomies were done by young surgeons. Compared with Patients who underwent open appendectomy, patients who underwent laparoscopic appendectomy were more female, had lower severity of illness and were less likely to have perforated appendicitis. Conversion rate in laparoscopic appendectomy was 10.8% and 36% in complicated appendicitis. Laparoscopic appendectomy was associated with a lower rate of overall complications (4.1% Vs 13.9%, p < 0.001), lower rate of wound infections (0% Vs 8.8%, p < 0.001), but higher rate of intra abdominal abscess (1.6% Vs 0%, p0.02). The duration of surgery was 10 minutes longer for laparoscopic appendectomy. There was a higher rate of negative appendectomy with open procedure. The length of hospital stay was shorter in the laparoscopic procedure. Conclusions: Laparoscopic appendectomy is known to be feasible and safe in all stages of acute appendicitis. The current analysis shows the advantages of the laparoscopic procedure especially in women of childbearing, in complicated appendicitis and in patients with atypical presentations. It may be safely introduced as a teaching procedure. We recommend its routine use.