Laparoscopy in the contemporary management of acute appendicitis

Background We sought to compare laparoscopic appendectomy (LA) with open appendectomy (OA) focusing on the negative appendectomy rate (NAR), emergency department (ED) to operating room (OR) time, procedure length, and histopathological correlation. Methods All appendectomies for appendicitis over a 6-year period at a single hospital were reviewed. Open and laparoscopic procedures were compared. Results There were 1,312 appendectomies (54.6% OA and 45.4% LA) Mean ED to OR time was as follows: LA 10.8 hours (standard deviation [SD] ± 9.0) versus 9.8 hours (SD ± 8.5) OA (P = .0333). Mean OR time was 61.2 minutes (SD ± 29.1) LA versus 57.7minutes (SD ± 28) OA (P = .0293). NAR was 18.3%, LA 23.3% versus14.0% OA (P < .0001). Postoperative correlation with histopathology was 86% for LA versus 92% OA (P = .0003). In the LA group, 9.9% with a “normal” appendix had appendicitis by histopathology. Conclusions LA is associated with increased presentation to procedure time, operative time, and negative appendectomy rate. Removing a “normal” appendix during LA in the absence of alternate pathology is recommended.