Comparison of clinical outcomes and hospital cost between open appendectomy and Laparoscopic appendectomy

( Ho Jun Lee ),( Yong Hwan Park ),( Jae Il Kim ),( Pyong Wha Choi ),( Je Hoon Park ),( Tae Gil Heo ),( Myung Soo Lee ),( Chul Nam Kim ),( Surk Hyo Chang ) 대한내과학회 2011 대한내과학회지 Vol.81 No.5

Purpose: Laparoscopic appendectomy has been recognized to have many advantages such as greater cosmetic results, less postoperative pain and shorter hospital stays. On the other hand, the cost of laparoscopic procedures is still more expensive than that of open procedures in Korea. The aim of this study is to compare clinical outcomes and hospital costs between open appendectomy and laparoscopic appendectomy. Methods: Between January 1, 2010 and December 31, 2010, 471 patients were diagnosed with acute appendicitis. Of these, 418 patients met the inclusion criteria and were divided into two groups of open appendectomy (OA) group and laparoscopic appendectomy (LA) group. We analyzed the clinical data and hospital costs. Results: The mean operation time for laparoscopic appendectomy (72.17 minutes) was significantly longer than that of open appendectomy (46.26 minutes) (P = 0.0004). The mean amounts of intravenous analgesics for OA group (2.00 times) was greater than that of LA group (1.86 times) (P < 0.0001). The complication rate was similar between the two groups (OA, 6.99% vs. LA, 10.87%; P = 0.3662). The mean length of postoperative hospital stay was shorter in LA group (OA, 4.55 days vs. LA, 3.60 days; P = 0.0002). The mean total cost covered by the National Health Insurance was more expensive in LA group (OA, 1,259,842 won [Korean monetary unit] vs. LA, 1,664,367 won; P = 0.0057). Conclusion: Clinical outcomes of laparoscopic appendectomy were superior to that of open appendectomy even though the cost of laparoscopic appendectomy was more expensive than that of open appendectomy. Whenever surgeons manage a patient with appendicitis, laparoscopic appendectomy should be considered as the procedure of choice.

Comparison of clinical outcomes and hospital cost between open appendectomy and laparoscopic appendectomy

Ho Jun Lee,Yong Hwan Park,Jae Il Kim,Pyong Wha Choi,Je Hoon Park,Tae Gil Heo,Myung Soo Lee,Chul Nam Kim,Surk Hyo Chang 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.81 No.5

Purpose: Laparoscopic appendectomy has been recognized to have many advantages such as greater cosmetic results, less postoperative pain and shorter hospital stays. On the other hand, the cost of laparoscopic procedures is still more expensive than that of open procedures in Korea. The aim of this study is to compare clinical outcomes and hospital costs between open appendectomy and laparoscopic appendectomy. Methods: Between January 1, 2010 and December 31, 2010, 471 patients were diagnosed with acute appendicitis. Of these, 418 patients met the inclusion criteria and were divided into two groups of open appendectomy (OA) group and laparoscopic appendectomy (LA) group. We analyzed the clinical data and hospital costs. Results: The mean operation time for laparoscopic appendectomy (72.17 minutes) was significantly longer than that of open appendectomy (46.26 minutes) (P = 0.0004). The mean amounts of intravenous analgesics for OA group (2.00 times) was greater than that of LA group (1.86 times) (P < 0.0001). The complication rate was similar between the two groups (OA, 6.99% vs. LA, 10.87%; P = 0.3662). The mean length of postoperative hospital stay was shorter in LA group (OA, 4.55 days vs. LA, 3.60 days; P = 0.0002). The mean total cost covered by the National Health Insurance was more expensive in LA group (OA, 1,259,842 won [Korean monetary unit] vs. LA, 1,664,367 won; P = 0.0057). Conclusion: Clinical outcomes of laparoscopic appendectomy were superior to that of open appendectomy even though the cost of laparoscopic appendectomy was more expensive than that of open appendectomy. Whenever surgeons manage a patient with appendicitis, laparoscopic appendectomy should be considered as the procedure of choice.

충수주위 농양 환자의 치료로서 간격 충수절제술과 응급 충수절제술의 비교

조성욱,김인규,이봉화 대한대장항문학회 2003 Annals of Coloproctolgy Vol.19 No.5

Transumbilical Laparoscopic Assisted Single Port Appendectomy (Hybrid Appendectomy) in Children

한상협,이진원,한정희,김해성,류병윤 대한내시경복강경외과학회 2012 Journal of Minimally Invasive Surgery Vol.15 No.4

Purpose: Laparoscopic appendectomy isused as a three port technique for appendectomy. In children, single port laparoscopic appendectomy is difficult because they have a small peritoneal cavity for manipulation of laparoscopic instruments. We performed transumbilical laparoscopic assisted single port appendectomy (hybrid appendectomy) in children. Methods: From March 2010 to July 2012, we performed transumbilical laparoscopic assisted single port appendectomy in 53 children. We made a vertical incision to the umbilicus approximately 1.5 cm, and a wound retractor (Applied Medical Resources Co., Ltd., Rancho Santa Margarita) was placed in the umbilical incision, and appendix exteriorized the extraperitoneum through the wound retractor. Appendectomy was performed conventionally. We had no conversion cases for laparotomy. Results: A total of 53 patients, 29 females and 24 males,with a mean age of 8.5±2.0 years were enrolled in this retrospective study. The mean operative time was 29.4±9.4minutes. There was no occurrence of complication or mortality. BMI was 17.8±4.9 kg/m2. And mean hospital stay was 3.2±1.0days. Conclusion: In children, transumbilical single port laparoscopic appendectomy is technically difficult because they have a small peritoneal cavity. However, transumbilical laparoscopic assisted single port appendectomy (hybrid appendectomy) appearsto be a safe and effective technique for use in children,which allows for achievement of nearly scarless surgery.

복강경 충수절제술의 임상적 고찰

이민화,송병주,최상용,박신희,김진승 대한대장항문학회 1998 Annals of Coloproctolgy Vol.14 No.3

복강경 충수절제술에서 개복술 전환의 위험인자

윤형식,백용해,최원용,곽범석,김연대,박영진,오민구,김홍용 대한내시경복강경외과학회 2010 Journal of Minimally Invasive Surgery Vol.13 No.2

Purpose: Laparoscopic appendectomy has recently been performed more frequently than open appendectomy because of its advantages. Yet laparoscopic appendectomy has the risk of converting to open appendectomy. We evaluated the preoperative evaluation factors that can influence the rate of conversion to open appendectomy. Methods: For the 255 patients admitted to our hospital, we reviewed their medical history, their clinical and laboratory examination etc. and the final diagnosis was made by CT scan. The preoperative characteristics of the patients who underwent laparoscopic appendectomy and the patients who were converted to open appendectomy were compared using univariate and multivariate analysis. Results: Out of 255 patients who underwent laparoscopicappendectomy,15 patients (5.8%) were converted to open appendectomy. The main reasons were adhesion and periappendiceal abscess formation. Periappendiceal fat infiltration (p=0.030) seen in the CT scan and perforation (p=0.019) were significant risk factors associated with converting to open appendectomy. Conclusion: Periappendiceal fat infiltration and perforation seen on preoperative CT scanning are important when considering performing laparoscopic appendectomy. Identifying the potential preoperative factors for conversion may assist surgeons when making decisions concerning the management of patients with appendicitis and for the judicious use of LA.

단일공 복강경 충수절제술의 초기 경험

정원준,김형진,강원경,조현민,김준기,오승택,이상철 대한내시경복강경외과학회 2010 Journal of Minimally Invasive Surgery Vol.13 No.2

Purpose: With the big increase in laparoscopic skills and technology, many surgeons have recently began to adopt single port laparoscopic surgery for treating appendicitis due to the increased patient satisfaction and improved cosmesis. We determined if conventional appendectomy or single port laparoscopic appendectomy is the better treatment modality figure out which one will be. Methods: The data was prospectively collected and retrospectively analyzed for all the patients who underwent single port laparoscopic appendectomy at our institute and this data was compared with that of the patients who had undergone conventional laparoscopic appendectomy. Results: 55 patients underwent single port laparoscopic appendectomy and we collected the data of 76 patients who underwent conventional laparoscopic appendectomy. There were few differences between single port laparoscopic appendectomy and conventional laparoscopic appendectomy for the operation results. Conclusion: Single port laparoscopy appendectomy is feasible and safe with several benefits. It can be a good treatment modality for the management of appendicitis. Surgeons familiar with conventional laparoscopy can switch to single port laparoscopy for performing appendectomy without need of special skills or training to get over the learning curve.

급성충수염 환아에서 복강경 충수절제술과 Needlescope을 이용한 충수절제술의 비교

김용석,곽금희,양근호,배병노,김기환,한세환,김홍주,김영덕,김홍용 대한내시경복강경외과학회 2010 Journal of Minimally Invasive Surgery Vol.13 No.2

Purpose: This clinical study evaluated the feasibility of needlescopic appendectomy (NA) in young patients with acute appendicitis, and we compare the outcome of this new technique with that of conventional laparoscopic appendectomy (LA). Methods: Two groups of young patients who underwent laparoscopic appendectomy at Sanggye Paik Hospital between January 2009 and December 2009 were studied. In the first group, a 2-mm instrument appendectomy was performed in 13 patients. These patients were compared with the second group, which were 21 patients who underwent conventional laparoscopic appendectomy. Statistical significance was set at p values<0.05. Results: The patient demographics and operative findings were similar in both groups. There was no conversion to open appendectomy in either group. Postoperative ileus was occurred in 3 patients who underwent LA, but there was no statistical difference between the both groups (p=0.154). The needlescopic group had a shorter mean operative time (p=0.65), but there was no statistically significance. The mean hospital stay was significantly shorter (p=0.026) in the needlescopic group than that in the conventional laparoscopic group. Conclusion: According to our experience, needlescopic laparoscopic appendectomy is a safe and feasible procedure as compared with that of conventional laparoscopic appendectomy in young patients.

복강경 충수절제술의 임상적 유용성

신준호,박용래,김흥대 대한대장항문학회 1998 Annals of Coloproctolgy Vol.14 No.3

Learning Curve for a Laparoscopic Appendectomy by a Surgical Trainee

김송이,홍성권,노혜린,박승배,김양희,채기봉 대한대장항문학회 2010 Annals of Coloproctolgy Vol.26 No.5

Purpose: The laparoscopic appendectomy has been a basic part of the principal of a more complex laparoscopic technique for the surgical trainee. As the number of laparoscopic appendectomies performed by surgical trainees has increased, we are trying to check the stability of, which is controversial, and the learning curve associated with a laparoscopic appendectomy. Methods: We studied the demographics, histologic diagnoses, operative time, the number of complicated cases, and hospital duration of one hundred and three patients who underwent an open appendectomy (group A, 53) or a laparoscopic appendectomy (group B, 50) retrospectively through a review of their medical records. The learning curve for the laparoscopic appendectomy was established through the moving average and ANOVA methods. Results: There were no differences in the operative times (A, 64.15 ± 29.88 minutes; B, 58.2 ± 20.72 minutes; P-value, 0.225)and complications (A, 11%; B, 6%; P-value, 0.34) between group A and group B. Group B was divided into group C who underwent the operation in the early period (before the learning curve) and group D who underwent the operation in the later period (after the learning curve). The average operative time for group C was 66.83 ± 21.55 minutes, but it was 45.25± 10.19 minutes for group D (P-value < 0.0001). Although this difference was statistically significant, no significant difference in the complication rate was observed between the two groups. Conclusion: A laparoscopic appendectomy, compared with an open appendectomy, performed by a surgical trainee is safe. In this study, the learning curve for a laparoscopic appendectomy was thirty cases.