Resumo

TORO, Juan Pablo; BARRERA, Óscar Javier  e  MORALES, Carlos Hernando. Clinical superiority of laparoscopic appendectomy over the open technique: sluggish adoption of a new standard of treatment?. rev. colomb. cir. [online]. 2017, vol.32, n.1, pp.32-39. ISSN 2011-7582.  https://doi.org/10.30944/20117582.5.

Introduction: Appendectomy is one of the most commonly performed procedures by general surgeons. Current tendency is towards an increasing use of laparoscopic technique; however, its routine implementation is still controversial. Aim: To compare clinical outcomes of the open (OA) and laparoscopic (LA) appendectomy techniques at a single tertiary level of care institution. Methods: Cohort study in patients that underwent appendectomy during a four-year period. Perioperative and postoperative variables were compared. Factors related to surgical site infection (SSI) were determined by multivariate analysis. Results: 600 patients were included: 389 OA and 211 LA. Demographic characteristics were similar in both groups. Mean operative time was longer in LA, 30.3min vs 24.4min (p<0.01), there were no conversions to the open technique. There were more complications in OA compared to LA (15.1% vs 3.7% respectively), furthermore OA had a tendency towards longer hospital stay and reoperation. OA patients had higher incidence of incisional SSI (8.7% vs 2.8%, p=0.01). LA was not related to higher incidence of organ/space SSI (RR 0.98, CI 0.97-1.00). Obesity, complicated appendicitis, and open surgical technique, were related to the development of SSI (p<0.01). Conclusion: Laparoscopic appendectomy is superior in clinical outcomes as compared to the open technique. This is especially true because LA decreases the incidence of incisional and organ/space SS. In consequence, we recommend its routine implementation in our country.

Palavras-chave : appendicitis; appendectomy; laparotomy; laparoscopy; quality assurance; health care; postoperative complications; surgical wound infection.

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