Laparoscopy in the contemporary management of acute appendicitis

Background: We sought to compare laparoscopic appendectomy (LA) with open appendectomy (OA) focusing on the negative 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 57.7 minutes (SD +/- 28) OA (P = .0293). NAR was 18.3%, LA 23.3% versus 14.0% 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. (c) 2007 Excerpta Medica Inc. All rights reserved.