A randomized comparison of gasless laparoscopic appendectomy and conventional laparoscopic appendectomy

INTRODUCTION: The purpose of this study was to compare the clinical outcomes and cost effectiveness of the gasless laparoscopic appendectomy (GLA) and conventional laparoscopic appendectomy (LA). METHODS: From Aug 2010 to Feb 2012, 100 patients with a clinical diagnosis of acute appendicitis in Shanghai Tongji hospital were included in the study and randomly divided into the LA and GLA groups, fifty in the GLA group and 50 in the LA group. The two groups were comparable in age, gender, body mass index, symptom duration, ASA score, and white blood cell count. RESULTS: The mean surgical duration was 70.6 ± 30.8 min in the GLA group and 62.6 ± 22.0 min in the LA group (P = 0.138). The total conversion rate was 8% in the GLA group, while no conversions occurred in the LA group. Postoperative complications did not significantly differ between the two groups. Fentanyl consumption was decreased significantly in the GLA group (P = 0.019) postoperatively. The length of the total hospital stay was 4.36 ± 1.74 days in the GLA group compared with 5.68 ± 4.44 days in the LA group (P = 0.053). There was a significant decrease in the total hospital cost when the GLA group was compared with the LA group (6659 ± 1782 vs. 9056 ± 2680 Yuan, respectively, P < 0.001). CONCLUSION: GLA and conventional LA are comparable in terms of operative duration, complications, and total hospital stay. The obvious advantage of GLA is the significantly reduced hospital cost. The demand for postoperative analgesics may also decrease following GLA. In conclusion, GLA is a safe and feasible procedure in selected patients. TRIAL REGISTRATION: Chinese Clinical Trial Register ChiCTR-TRC-10001203.