Critical comparison of diagnostic laparoscopy and appendectomy versus open appendectomy for the evaluation of acute right lower quadrant pain

K. Lesley Birmingham, Nathan Feingenbaum, I. Michael Leitman, Anthony J. Tortolani

Research output: Contribution to journalArticlepeer-review

Abstract

Technical advances in general laparoscopic surgery have allowed its application toward an increasing number of procedures. Diagnostic laparoscopy and appendectomy (DLA) was performed for the evaluation of acute right lower quadrant abdominal pain in 109 patients in a large teaching hospital over a 24-month period. These procedures were compared with 46 open appendectomies (OA) performed during the 12-month period proceeding the institution of DLA. Three patients were converted from laparoscopic to open appendectomy (3%), only one of these for technical reasons. The DLA and OA groups were comparable with regard to age, sex, duration of symptoms, presenting findings, average temperature, which blood cell count (WBC), and preoperative radiologic studies. Twenty-three patients who underwent DLA had prior transabdominal surgery; 13 having prior lower abdominal surgery, without requiring a conversion to open appendectomy. The average operative time during laparoscopic surgery was 62.4 minutes compared to 54.6 minutes for OA (p > 0.05). Seven patients in the DLA group were thought to have a normal appendix; however, 2 were verified pathologically to have histologic appendicitis. The overall pathologically negative appendectomy rate in the laparoscopic group was 12 of 106 (11%) versus 2 of 46 (7%). Other significant pathologic findings requiring surgical intervention were found in 7 of the patients undergoing laparoscopic evaluation (2 requiring conversion to open procedure) and 4 other patients who underwent OA. Complication rates were not significantly different between the two groups (15% DIA, 26% OA). Ninety-two percent of the patients were tolerating clear liquids by the first postoperative day in the DLA group compared to 41% of patients who underwent OA (p < 0.05). Eighty-eight percent of DLA patients were tolerating a regular diet by the second postoperative day compared to 39% of the OA patients (p < 0.05). The average length of stay in the DLA group was 2.8 days compared with 5.4 days in the open appendectomy group (p < 0.05).

Original languageEnglish
Pages (from-to)231-234
Number of pages4
JournalCurrent Surgery
Volume53
Issue number4
StatePublished - May 1996
Externally publishedYes

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