Why an appendicectomy now takes 2 hrs…

Pedersen AG, Petersen OB, Wara P, Rønning H, Qvist N & Laurberg S. Randomized clinical trial of laparoscopic versus open appendicectomy. British Journal of Surgery 2001; 88: 200-205.

RHH Journal Club. June 20th, 2013. Dr Sunita Asif

No free full-text available

Is laparoscopic appendicectomy superior to open appendicectomy?

Study design:

  • Randomised controlled trial
  • 2 University Hospitals  (Denmark)
  • 19 months

Methodology:

Population:

Inclusion criteria – Clinical diagnosis of acute appendicitis n=828 patients

Exclusion criteria -Contraindications to carbon dioxide pneumoperitoneum

Randomisation:

583 patients consented to randomisation

245 patients not randomised, underwent open surgery and included in the trial

Lack of consent was main reason for non-randomisation

Computer generated and sealed envelope method of randomisation

Intervention:

Randomised to have either laparoscopic or open appendicectomy; Surgery performed by registrars

Primary endpoint:

  • Length of hospital day (days)
  • Secondary endpoints:
  • Operating time (minutes)

Postoperative morbidity

  • Cosmesis
  • Time to resume normal activity and work (day)

Validity:

  • Were all patients randomised? No, 245 patients not randomised
  • Was randomised concealed? Yes,
  • Were the groups similar? No, greater number of patients in open  group
  • Intention to treat principle used? Yes
  • Follow up complete? Yes, 80% patients followed up in outpatient clinic 4 weeks post discharge

Results:

Patients well matched for age, gender and weight but not for severity of appendiceal pathology, resulting in significantly fewer patients with gangrenous/perforated appendix randomised to open group

  •                 282 patients randomised to laparoscopic appendicectomy
  •                 301 patients randomised to open appendicectomy

High conversion rate (23%), making interpretation challenging as these patients received same treatment modality as the patients in the comparative (open)  group

Primary endpoint: 

  • Median hospital stay of 2 days in both groups

Secondary endpoints:

In laparoscopic group :

  • Longer operating time (60mins Vs 40mins)
  • Statistically significant fewer wound infections
  • More intra peritoneal abscesses, but adjusted for greater no. of gangrenous/perforated appendices in this group, not significant
  • Statistically significant improved cosmesis
  • Statistically significant shorter median time to return to normal activity (7 vs 10 days) and work (10 vs 16 days )

Conclusion

  • Hospital stay equally short in both groups
  • Laparoscopic appendicectomy is associated with fewer wound infections, improved cosmesis, earlier return to normal activity and work but longer operating times.

 

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