Comparison Of Laparoscopic Vs Open Appendicectomy In A Low-Volume General Hospital. A Pilot Study

Abstract

Introduction: Laparoscopy is a safe procedure for diagnostic and therapeutic purposes in patients with suspected acute appendicitis. Nevertheless, the optimal approach in a low-volume hospital is still under debate. Aim: In this pilot study we are testing the laparoscopic approach against the traditional open technique in terms of postoperative pain, gastrointestinal quality of life and return to normal physical activities. Patients Methods: Forty patients with right iliac fossa pain were randomised into two groups after written informed consent. Group A consisted of 20 patients who underwent laparoscopy and laparoscopic appendicectomy. Group B included 20 patients submitted to open appendicectomy by the same single surgeon. The postoperative pain (Numeric Rating Scale 1-10), the need for analgesics (number of tramadol 100mg doses) and the functional status (climbing stairs and mounting a bed – 1 = no difficulty, 2 = moderate difficulty and 3 = severe difficulty) were measured at days 1, 2 and 7 after the operation. The presence of bowel sounds was also checked 6, 12, 24 and 48 hours postoperatively. Results: The two groups were comparable in age and gender. There was no significant difference in the operative time (p = 0.666), postoperative pain on day 1 (p = 0.113) and function score. Group A had significantly less pain on days 2 and 7 (p = 0.014 and p < 0.001, respectively), less need for opioids (p = 0.05), earlier bowel mobilisation (p = 0.006) and shorter hospital stay (p = 0.014). Conclusions: Laparoscopic appendicectomy in a low-volume district hospital is a safe operation if performed by experienced surgeons. With the limitations of the small samples size, laparoscopic approach was superior to open in terms of postoperative pain, need for analgesics, bowel mobilisation and hospital stay.