Laparoscopy in the contemporary management of acute appendicitis

Ekeh, Akpofure Peter; Wozniak, Curtis J.; Monson, Benjamin; Crawford, Joseph; McCarthy, Mary C.

doi:10.1016/j.amjsurg.2006.09.025

« Previous Next »The American Journal of Surgery
Volume 193, Issue 3 , Pages 310-314, March 2007

Laparoscopy in the contemporary management of acute appendicitis

Presented at the 49th Annual Meeting of the Midwest Surgical Association, Mackinac Island, MI, August 6–9, 2006

Department of Surgery, Wright State University, CHE 7000, Miami Valley Hospital, 1 Wyoming Street, Dayton, OH 45459, USA

Received 12 August 2006; received in revised form 20 September 2006

Abstract

Background

We sought to compare laparoscopic appendectomy (LA) with open appendectomy (OA) focusing on the negative appendectomy rate (NAR), emergency department (ED) to operating room (OR) time, procedure length, and histopathological correlation.

Methods

All appendectomies for appendicitis over a 6-year period at a single hospital were reviewed. Open and laparoscopic procedures were compared.

Results

There were 1,312 appendectomies (54.6% OA and 45.4% LA) Mean ED to OR time was as follows: LA 10.8 hours (standard deviation [SD] ± 9.0) versus 9.8 hours (SD ± 8.5) OA (P = .0333). Mean OR time was 61.2 minutes (SD ± 29.1) LA versus 57.7minutes (SD ± 28) OA (P = .0293). NAR was 18.3%, LA 23.3% versus14.0% OA (P < .0001). Postoperative correlation with histopathology was 86% for LA versus 92% OA (P = .0003). In the LA group, 9.9% with a “normal” appendix had appendicitis by histopathology.

Conclusions

LA is associated with increased presentation to procedure time, operative time, and negative appendectomy rate. Removing a “normal” appendix during LA in the absence of alternate pathology is recommended.

Keywords: Laparoscopic appendectomy, Open appendectomy, Negative appendectomy rates, Normal appendix