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Laparoscopic versus open appendectomy: a prospective randomized double-blind study.

Abstract：

SUMMARY BACKGROUND DATA: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:Two hundred forty-seven patients were analyzed following either laparoscopic or open appendectomy. A standardized wound dressing was applied blinding both patients and independent data collectors. Surgical technique was standardized among 4 surgeons. The main outcome measures were postoperative complications. Secondary outcome measures included evaluation of pain and activity scores at base line preoperatively and on every postoperative day, as well as resumption of diet and length of stay. Activity scores and quality of life were assessed on short-term follow-up. RESULTS:There was no mortality. The overall complication rate was similar in both groups (18.5% versus 17% in the laparoscopic and open groups respectively), but some early complications in the laparoscopic group required a reoperation. Operating time was significantly longer in the laparoscopic group (80 minutes versus 60 minutes; P = 0.000) while there was no difference in the pain scores and medications, resumption of diet, length of stay, or activity scores. At 2 weeks, there was no difference in the activity or pain scores, but physical health and general scores on the short-form 36 (SF36) quality of life assessment forms were significantly better in the laparoscopic group. Appendectomy for acute or complicated (perforated and gangrenous) appendicitis had similar complication rates, regardless of the technique (P = 0.181). CONCLUSIONS:Unlike other minimally invasive procedures, laparoscopic appendectomy did not offer a significant advantage over open appendectomy in all studied parameters except quality of life scores at 2 weeks. It also took longer to perform. The choice of the procedure should be based on surgeon or patient preference.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Katkhouda N,Mason RJ,Towfigh S,Gevorgyan A,Essani R

doi

10.1097/01.sla.0000179648.75373.2f

subject

Has Abstract

pub_date

2005-09-01 00:00:00

pages

439-48; discussion 448-50

issue

eissn

0003-4932

issn

1528-1140

pii

00000658-200509000-00015

journal_volume

242

pub_type

临床试验,杂志文章,随机对照试验

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Laparoscopic versus open appendectomy: a prospective randomized double-blind study.