복강경 충수돌기 절제술에서 관찰된 불필요한 수술의 증가
Laparoscopic Appendectomy Increased Unnecessary Operation Compared with Open Appendectomy
이환봉, 이재규, 이병찬,
소속 상세정보
이환봉 ( Lee Hwan-Bong )
원광대학교 의과대학 외과학교실
이재규 ( Lee Jai-Kyoo )
원광대학교 의과대학 응급의학교실
이병찬 ( Lee Byung-Chan )
원광대학교 의과대학 외과학교실
KMID : 0978820030060010049
Abstract
Purpose: Laparoscopic appendectomy (LA) is accepted world widely as the first choice of treatment in suspected appendicitis. Its rationale is rapid and favorable recovery in many reports even in complicated appendicitis also, for which some surgeons, however, are reluctant to agree with. We have been performing LA by one surgeon and open appendectomy (OA) by another at the same period to compare above issue prospectively between each other.
Methods: During one year from July 1998, 155 each cases of LA and OA performed by each surgeon were chart reviewed in view of missed diagnoses and clinical courses including complications. Patients were assigned to each surgeon alternatively as they arrive after decision of operation though discussion.
Results: One hundred fifty-five LA included 33 (21.3%) cases of operations from other than appendicitis, among which 27 cases (17.4%) was unnecessarily operated, while OA showed 24 cases (15.4%) of other pathologies where 15 operations (9.7%) were unnecessary. Sixteen cases (10.3%) were converted from LA to OA due to technical difficulty leading to delayed operation time and recovery course (p＜0.05), with 3 misdiagnoses and 2 unnecessary operations in them.
Conclusion: Trial of LA induced the surgeon to determine operation more easily, leading to more frequent unnecessary operations (p＜0.05), and prolonging operation and recovery time in converted cases. Higher rate of unnecessary operation by LA should always be kept in mind when deciding whether to operate by LA or OA.
키워드
충수돌기염;복강경;불필요한 복부수술
Appendicitis;Laparoscope;Unnecessary laparotomy
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