Abstract
Background
Laparoscopic appendicectomy (LA) offers faster recovery times and a reduced rate of wound infection compared with open appendicectomy (OA) but may be associated with more intra-abdominal abscesses. This study examines the changing trends in management of appendicitis in a regional setting during service reorganization and compares infective complication rates for each procedure.
Methods
Data were retrieved from the Lothian Surgical Audit database on 1824 patients treated for appendicitis by OA or LA during equal 31-month periods before and after service reorganization in August 2002. Outcome measures were duration of admission, recovery time from operation to discharge and reintervention for infective complications. Analysis was by intention to treat.
Results
The rate of LA in Lothian increased from 29ยท9 to 39ยท4 per cent (P < 0ยท001) after subspecialist service reorganization. Recovery time from operation to discharge was significantly shorter after LA than OA when results were stratified with respect to sex (mean 2ยท5 versus 4ยท4 days respectively in women, P < 0ยท001; 2ยท7 and 3ยท1 days in men, P = 0ยท023), timing of surgery (2ยท7 versus 3ยท3 days before subspecialization, P = 0ยท007; 2ยท5 versus 3ยท6 days after subspecialization, P < 0ยท001) and whether appendicitis was associated with peritoneal contamination (2ยท2 versus 3ยท0 days for uncontaminated surgery, P < 0ยท001; 4ยท3 versus 5ยท1 days for contaminated surgery, P = 0ยท060). Peritoneal contamination at primary operation was the only independent risk factor that predicted reintervention for infective complications.
Conclusion
LA is associated with a shorter hospital stay from operation to discharge than OA, with no evidence of an increased rate of intra-abdominal infective complications.