A quality of life comparison of laparoscopic and open approaches in acute appendicitis: a randomised prospective study

M. Kaplan, Mehmet Kaplan, B. Salman, Tonguç Utku Yılmaz, T U Yilmaz, Mehmet Oğuz, M Oguz
Acta chirurgica Belgica · 2009 · vol. 109(3) , pp. 356–363 · doi:10.1080/00015458.2009.11680439 · PMID:19943593 · W173301145
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This randomized prospective study found that laparoscopic appendectomy led to significantly better quality of life, shorter hospital stays, and less pain compared to the open approach.

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Abstract

BACKGROUND AND OBJECTIVES: The study aimed to evaluate the utility of a laparoscopic approach in the management of patients with right lower abdominal pain and in the quality of life after the operation. METHODS: Patients with suspected appendicitis were included in the study. They were randomly assigned either to treatment with a traditional open approach or with a laparoscopic approach. The patients' data, including demographic data, complications and gastro-intestinal quality of life index scores, were collected at the 6th week and 6th month and compared between the groups. RESULTS: Overall, 83 appendectomies were performed. Other pathologies were ovulation bleeding, ovarian cyst, Meckel's diverticulum, ectopic pregnancy and leiomyoma of the uterus. Negative appendectomy rate was 7%. Severe infection occurred in five of the open group. The advantages of the laparoscopy also showed significantly in hospital stay (55.80 +/- 20.97 hours vs. 75.06 +/- 35.14 hours), the need for narcotics and in visual analog score, as well as in the gastrointestinal quality of life index (85.88 +/- 9.73 vs 101.30 +/- 9.31). The quality of life is still better in the long-term (95.14 +/- 8.45 vs 120.36 +/- 10.25). When the groups were compared according to the subgroups of gastro-intestinal quality of life index, except for disease-specific items, in all categories a significant improvement was seen in the laparoscopically treated patients. This improvement was observed in the follow-up period also. However, the hospital costs (987.50 +/- 77.25 USD vs. 406.27 +/- 100.59 USD) and operative time (56.25 +/- 10.9 vs. 49.41 +/- 11.76 minutes) still continued to be a problem for the laparoscopic group. CONCLUSION: Laparoscopic appendectomy is a safe method, which also has advantages of diagnostic procedure for other pathologies, a better quality of life both in the early and late period, and a short hospital stay. The important advantage is also seen in the late period with better quality of life.

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MeSH descriptors

Appendectomy Appendicitis Laparoscopy Laparotomy Quality of Life Acute Disease Adolescent Adult Aged Appendectomy Appendicitis Appendicitis Female Follow-Up Studies Humans Laparoscopy Laparotomy Length of Stay Male Middle Aged

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