A Comparison of Laparoscopic versus Open Appendectomy for Overweight Patient in Bangkok Metropolitan Administration General Hospital: Retrospective Study

Abstract

Background. Systematic reviews and randomized controlled trials comparing laparoscopic appendectomy (LA) with open appendectomy (OA) show a reduction in length of hospital stay (LOS), wound infections associated with LA and recommend the routine use of LA in young women and overweight people. There are minimal data comparing LA with OA in Asia-pacific overweight patients and no data in Thailand.

Objectives. Primary outcome is LOS. Secondary outcomes were operative time, time to resume diet and post-operative complications.

Methods. We retrospectively analyzed the medical records of overweight patients (BMI ≥ 23kg/m²) in Bangkok Metropolitan Administration General Hospital with acute appendicitis who underwent LA and OA from January 2012 through December 2017.

Results. There were 136 (71 male, 65 female) overweight patients underwent appendectomy. Subjects were divided into 2 groups; 68 in LA and 68 in OA. Median LOS for LA was better, 58.5 hours versus 85.5 hours for OA (P < 0.01), median operative blood loss for LA was better, 5 ml versus 20 ml for OA (P < 0.01) and primary wound closure rate was better, 100% for LA versus 85% for OA (P = 0.001). Other outcome measures were equivalent.

Conclusions. LA can be performed safely with shorter LOS, less delayed primary wound closure and less operative blood loss in overweight patients and should be considered the procedure of choice for overweight patients with appendicitis.