American Surgical Association
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29. Laparoscopic Versus Open Appendectomy: A Randomized Double Blind Study
Namir Katkhouda, MD*, Rodney Mason, MD*, Anna Gevorgyan, MD*, Rahila Essani, MD*, Shirin Towfigh, MD*
University of Southern California, Los Angeles, CA (Sponsored by: Thomas Berne, MD)

OBJECTIVES: The value of laparoscopy in appendicitis is not established. Studies suffer from multiple limitations. Our aim is to compare the safety and benefits of laparoscopic versus open appendectomy in a prospective, randomized, double-blind study.

METHODS: 250 patients underwent either laparoscopic or open appendectomy. A standardized wound dressing was applied blinding both patients and independent data collectors to the type of operation. Surgical technique was standardized among four surgeons. The main outcome measures were postoperative complications. Secondary measures included pain, activity and quality of life scores at baseline and on every post-operative day, as well as resumption of diet and length of stay. Activity, quality of life and satisfaction were assessed on short-term follow up.

RESULTS: There was no mortality. The overall complication rate was similar in the laparoscopic and open groups (28% vs.32%, respectively). Laparoscopy took significantly longer (84min ± 37 vs.64 min ± 27; P<0.001) while there was no difference in the pain scores and medications, resumption of diet, or length of stay. At two weeks, activity and quality of life scores were significantly better in the laparoscopic group (P < 0.001). Appendectomy for acute and complicated (gangrenous and perforated) appendicitis had similar postoperative complication rates and pain, regardless of technique (P>0.05).

CONCLUSION: Unlike other minimally invasive procedures, laparoscopic appendectomy did not offer a significant advantage over open appendectomy in all parameters except activity and quality of life at two weeks. It also took longer to perform.

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