Laparoscopic vs Open Appendicectomy.

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Laparoscopic vs OpenAppendicectomy.

• Prince Of Wales Journal Club
• Sim Choroomi

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The Study

• Laparoscopic Versus Open Appendectomy A
  Prospective Randomized Double-Blind Study
• Annals of Surgery Volume 242, Number 3,
  September 2005
• Katkhouda, Namir MD Mason, Rodney J. MD
  Towfigh, Shirin MD Gevorgyan, Anna MD Essani,
  Rahila MD
• Division of Emergency Non-Trauma Surgery, and
  Minimally Invasive Surgery Program, University of
  Southern California, Keck School of Medicine, Los
  Angeles, California.

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Introduction

• 7-8 Life time risk.

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The Study

• Inclusion Criteria
• Appendicitis
• Clinical and/or laboratory findings
• 16 years or over
• Exclusion Criteria
• Uncertain diagnosis
• History gt5days, clinical suggestion of abscess or
  generalised peritonitis
• Certain co morbidities eg. cirrhosis
• Randomisation Informed consent and given a
  number (computer generated), lap vs open

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The Study

• Surgery
• Performed by surgical residents
• Standardised operation for lap and open
• Blinding
• 3 wound dressings and an abdominal binder were
  applied to every patient to blind the patient,
  nursing, medical staff and the independent data
  collector.
• Post-op
• Strict criteria for introduction of nutrition and
  discharge.

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The Study

• Outcome Parameters
• Anesthesia time in minutes
• Complications
• Time until resumption of diet
• Indications for conversion from LA to OA
• A 13-item Activity Assessment Scale
• Postoperative pain was assessed
• Quantitative and qualitative
• 2 weeks wound clinic and checked for
  complications and filled a survey

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Results
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Results

• Nine lap converted to open
• Pathology Six normal specimens.

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Results
10
Results

• Overall complication rate similar.
• The most serious early complications occurred in
• the laparoscopic group and required a
  re-operation injury
• of the epigastric vessels due to an inadequate
  port placement

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Results
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Conclusion

• Laparoscopic appendectomy did not offer a
  significant advantage over open
• All studied parameters similar, except time to
  perform operation and quality of life scores at 2
  weeks
• Slightly higher early complication rate in lap,
  overall similar complication rates

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The Study

• Strengths
• Blinded RCT
• All done in one centre
• 4 Surgeons supervising
• Comprehensive assessment of outcome measures and
  follow up
• Independent data collector
• Limitations
• ?Patient blinded with dressing
• Excluding those with uncertain diagnosis (mainly
  female) and peritonitis.
• Small number
• No cost analysis
• Follow up only at 2 weeks
• Population mainly Hispanic ethnicity

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What can we take from this?

• Laparoscopic appendectomy did not offer a
  significant advantage over open appendectomy
• However, this is based on a narrow spectrum,
  mainly male patients.
• Advantages of lap such as aiding diagnoses,
  greater exposure/access and cosmetic result.
• Prevention of bleeding from lap ports
• Choice of procedure is case specific and
  surgeon/patient preference.