A Cost-Effective Technique for Laparoscopic Appendectomy: Outcomes and Costs of a Case-Control Prospective Single-Operator Study of 112 Unselected Consecutive Cases of Complicated Acute Appendicitis

Abstract

presented by Dr Di Saverio at the Conference o Appendectomy,WorldTraumaCongress,RioDe Janeiro,Braz Received September 4, 2013; Revised November 20, 2 December 3, 2013. From the Emergency and General Surgery Departmen Maggiore Hospital, Bologna Local Health District, Bolog Mandrioli, Sibilio, Smerieri, Lombardi, Tugnoli, Masetti, gency and Trauma Surgery Department, Maggiore Hosp Parma (Catena), General and Emergency and Trauma S Ospedali Riuniti, Bergamo (Ansaloni), Italy, and Upper G Frenchay Hospital, North Bristol NHS Trust, Bristol, UK Correspondence address: Salomone Di Saverio, MD, PhD, General Surgery Department, CA Pizzardi Maggiore Ho Nigrisoli 2, 40133 Bologna, Italy. email: salo75@inwind.it ausl.bologna.it a 2014 by the American College of Surgeons Published by Elsevier Inc. SURGEON AT WORK A Cost-Effective Technique for Laparoscopic Appendectomy: Outcomes and Costs of a Case-Control Prospective Single-Operator Study of 112 Unselected Consecutive Cases of Complicated Acute Appendicitis Salomone Di Saverio, MD, PhD, Matteo Mandrioli, MD, Andrea Sibilio, MD, Nazareno Smerieri, MD, Raffaele Lombardi, MD, Fausto Catena, MD, PhD, FRCS, Luca Ansaloni, MD, PhD, FRCS, Gregorio Tugnoli, MD, PhD, FRCS, Michele Masetti, MD, PhD, FRCS, Elio Jovine, MD, PhD, FRCS Appendicitis is the most common cause of intra-abdominal surgical emergency in the Western world, and its differential diagnosis is often challenging because of several other conditions causing right iliac fossa pain. Ultrasound has a limited sensitivity (ranging from 74% to 83%) and better specificity (89% to 94%) compared with CT scan. However, although CT guarantees higher sensitivity rates (94%), it does carry the potential risks of radiation exposure. Since its introduction, open appendectomy (OA) has been the gold standard of care for more than a century. Laparoscopic appendectomy (LA) was first described in 1983, and some of its benefits were immediately clear, including better visualization of the peritoneal cavity, which made it possible to diagnosis alternative diseases in the case of a normal appendix, and improved cosmesis. However, the laparoscopic procedure has not superseded OA, even in Western countries, especially in hospitals with limited resources, equipment, and budget limitations, and where the surgical staff are dedicated to emergency surgery and potentially have poor laparoscopic skills. Cost effectiveness of LA is the greater matter of debate when choosing either open or laparoscopic approach. The first randomized trials showed that LA paradoxically increased n Laparoscopic il, August 2012.