Should a laparoscopic appendectomy be done?

For a laparoscopic appendectomy to be part of a surgical armamentarium, it should: 1) decrease hospital stay, 2) lessen narcotic requirement, 3) speed return to normal activity, 4) be cost effective, and 5) have fewer complications. To this end, we reviewed 60 consecutive cases of each appendectomy performed, laparoscopically and by open technique, during the period of 1993-1996. We looked not only at the above criteria, but also at the type of employment. Laparoscopic appendectomy did not decrease hospital stay (2.1 versus 1.4 days), or morphine equivalent narcotic requirement (38.5 mg versus 19.8 mg). However, laparoscopic appendectomy did carry a hospital bill of $3650.00 more than the open technique ($7923 versus $4273). This results not only from chargeable disposable items, but also from an increase in operative time (47 vs. 36 minutes) and room and anesthesia time (88 vs. 63 minutes), because of the increased length of preparation time. In only one category, patients involved in heavy manual activity (17 patients), the return to normal activity decreased by 1 week. There was no difference in complication rate in each category. Based on these findings, laparoscopic appendectomy cannot be recommended in suspected cases of appendicitis.