Department of Surgery, Khoo Teck Puat Hospital, Singapore.
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
JSLS. 2022 Apr-Jun;26(2). doi: 10.4293/JSLS.2022.00006.
Laparoscopic appendectomy (LA) is claimed to require less analgesic and allow for a faster return to work. This study examines whether these benefits hold true in Asian patient populations.
A retrospective audit of emergency appendectomies over one year was conducted to study outcomes of postoperative pain, length of stay (LOS), duration of analgesia, and hospitalization leave (HL). A telephone questionnaire evaluated post-discharge analgesic intake, residual symptoms at follow-up, adequacy of HL and opinion on teleconsult reviews.
Of the 201 patients, 187 (93%) underwent LA. Presurgery symptoms were significantly longer in the open appendectomy (OA) group (mean: OA 3.79, LA 1.81 days; =0.026) which also had a higher frequency of perforation (71.4%). LA patients reported less pain compared to OA (LA 3.60 vs. OA 4.14; =0.068) but were prescribed the same 2 weeks of analgesics as OA. LOS was significantly less for LA (mean LA 3.09, OA 6.93 days; =0.006). Mean HL for LA and OA were 17.9 and 21.8 days respectively (=0.05). Nearly 83% patients did not complete the prescribed course of analgesics and 47% patients felt that HL was more than adequate. Seventy-five percent of patients were asymptomatic at hospital follow-up and nearly 41% agreed to teleconsult reviews.
Majority of LA patients do not need 2 weeks of analgesics and their HL can be shortened for faster return to work thereby realizing the true benefits of minimally invasive surgery. Selected cases can be offered postoperative teleconsultation.
腹腔镜阑尾切除术（LA）据称需要较少的镇痛，并且可以更快地恢复工作。本研究检查这些益处是否适用于亚洲患者人群。
对一年中进行的急诊阑尾切除术进行回顾性审核，以研究术后疼痛、住院时间（LOS）、镇痛持续时间和住院假（HL）的结果。通过电话问卷调查评估出院后的镇痛摄入、随访时的残留症状、HL 的充分性以及对远程咨询审查的意见。
在 201 名患者中，187 名（93％）接受了 LA。开放阑尾切除术（OA）组的术前症状明显更长（平均：OA 3.79，LA 1.81 天；=0.026），穿孔的发生率也更高（71.4％）。LA 患者报告的疼痛比 OA 少（LA 3.60 与 OA 4.14；=0.068），但与 OA 一样开了 2 周的镇痛药。LA 的 LOS 明显更短（平均 LA 3.09，OA 6.93 天；=0.006）。LA 和 OA 的平均 HL 分别为 17.9 和 21.8 天（=0.05）。近 83％的患者没有完成规定的镇痛药疗程，47％的患者认为 HL 足够。75％的患者在医院随访时无症状，近 41％的患者同意进行远程咨询审查。
大多数 LA 患者不需要 2 周的镇痛药，并且可以缩短 HL，以更快地恢复工作，从而实现微创手术的真正益处。可以为选定的病例提供术后远程咨询。
