| Objective: Acute appendicitis is the highest incidence of acute abdominal disease, appendectomy is the reasonable treatment method for the disease. Several retrospective and prospective studies have shown advantages of laparoscopic appendectomy(LA) when compared with open appendectomy(OA), but the conclusion is controversial. The purpose of this study is to compare laparoscopic appendectomy with open appendectomy in operating time, bed off activity time, incision infection rate, intra-abdominal infection rate, peritoneal drainage rate, intestinal function recovery time, length of hospitalization(LOH), inhospital cost and readmission rate within 30 days for acute appendicitis patients, to clarify the difference between laparoscopic appendectomy and open appendectomy.Materials and Methods: This study retrospectively investigated the acute appendicitis clinical data from January 2013 to December 2014 who underwen appendectomy in our hospital of department of general surgery one. In line with screening patients enrolled a total of 200 cases included in this research. The 200 cases were divided into 1aparoscopic appendectomy group(LA group) and open appendectomy group(OA group), each group has 100 cases. We collected the baseline data in two groups, and the data in the operation time, bed off activity time,incision infection rate, intra-abdominal infection rate, intraperitoneal drainage rate, intestinal function recovery time, length of hospitalization, inhospital cost and readmission rate within 30 days. Finally, we analysis these data.Results: This retrospective study included 200 patients, each group of 100 cases. There was no significant difference in average age gender, and perforation between the two groups(P>0.05). LA was associated with a lower operating time(LA=54.84±18.84 min vs OA=64.00±23.89 min,P=0.003), wound infection rate(LA=2% vs OA=9%,P=0.030) and shoter bed off activity time(LA=9.99±3.29 h vs OA=19.56±5.58 h,P<0.001), intestinal function recovery time(LA=15.82±3.30 h vs OA=32.16±11.29 h,P<0.001) and shoter LOH(LA=4.11±1.77 d vs OA=5.15±2.21 d,P=0.021). But the intra-abdominal infection rate(LA=6% vs OA=5%,P=0.756), peritoneal drainage rate(LA=23% vs OA=16%,P=0.212) and readmission rate within 30 days(LA=1% vs OA=1%,P=1) were similar. Inhospital cost in LA group is higher than that in OA group(LA=13900±2600￥ vs OA=8800±4100￥, P<0.001). In the stratified analyses, we also analyzed the data in wound infection rate, intra-abdominal infection rate, peritoneal drainage rate and LOH by perforation status. For perforated appendicitis, the two group have no difference in incision infection rate(LA=12.5% vs OA=31.25%,P=0.317), intra-abdominal infection rate(LA=0 vs OA=6.25%,P=0.470), peritoneal drainage rate(LA=87.50% vs OA=56.25%,P=0.126) and LOH(LA=4.88±1.87 d vs OA=6.56±2.56 d,P=0.113). For noperforated appendicitis, There were no difference in the rates of incision infection, intra-abdominal infection and peritoneal drainage, but patients who underwent LA had shorter LOH(4.04 ±1.76 d vs 4.88±2.04 d,P=0.040). Results of the multivariable logistic regression(adjusting for gender, age, and perforation status, type of operation) are summarized. It demonstrated that LA was associated with higher peritoneal drainage rate(Odds Ratio [OR],2.710;95% Confidence Interval [CI],1.129-6.507).Conclusions: In the treatment of acute appendicitis, laparoscopic appendectomy and open appendectomy are both safe and effective method. Compared with open appendectomy, laparoscopic appendectomy has the advantages of early recovery, few complications and shorter length of hospitalization. But laparoscopic appendectomy is assosiated with higher inhospital cost and is an independent risk factor for abdominal drainage. Laparoscopic appendectomy can be used as the preferred method for treatment of acute appendicitis. |
