***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The aim of this study was to compare the outcome and cost-effectiveness of laparoscopic ( LA ) and open appendectomy ( OA ) . METHODS Forty consecutive patients were r and omized to either the LA ( n = 19 ) or OA ( n = 21 ) group . RESULTS The medians of operative times in the LA and OA groups were 31.5 and 41 min , respectively . The total operation room times were 91 and 82 min , respectively . There was no significant difference in postoperative pain or fatigue , but return to normal life was faster in the LA group ( 14 versus 26 . 5 days ) . The median hospital costs per patient were 8,538 and 6,788 FIM ( $ 1 US = 4.6 FIM ) in the LA and OA groups , respectively ; but the total costs among working patients were lower in the LA group ( 20 , 963 versus 27,778 FIM ) due to faster return to work . CONCLUSIONS Laparoscopic appendectomy is as safe as open appendectomy . The hospital costs are higher , but LA offers significant cost savings to the payer for working patients Background A prospect i ve study including 272 patients with suspected appendicitis was performed . The aims were to evaluate the representativity of the study group and to compare diagnostic and therapeutic laparoscopy with conventional appendicectomy Aim : To see whether laparoscopy improves the accuracy of a clinical diagnosis of acute appendicitis in women of reproductive age , and to determine what the long-term sequelae are of not removing an appendix deemed at laparoscopy to be normal . Method : The initial part of the study was undertaken during 1991–1992 . Female patients between 16 and 45 years were eligible for inclusion once a clinical decision had been made to perform an appendicectomy for suspected acute appendicitis . Following consent , patients were r and omized into two groups . One group had open appendicectomy , as planned . The other group had laparoscopy , followed by open appendicectomy only if the appendix was seen to be inflamed or was not visualized . The end points for the study were the clinical outcomes of all patients , and the results of histology , where appropriate . An attempt was made to contact all patients at 10 years to determine whether they had had a subsequent appendicectomy , or had been diagnosed with another abdominal condition that might be relevant to the initial presentation in 1991–1992 . Results : Laparoscopic assessment was correct in all cases in which the appendix was visualized . Diagnostic accuracy was improved from 75 % to 97 % . Laparoscopy was associated with no added complications , no increase in hospital stay in patients who went on to appendicectomy , and a reduction in hospital stay for those who underwent laparoscopy alone . No patients developed a problem over the 10-year follow-up period from having a normal-looking appendix not removed at laparoscopy . Conclusion : Laparoscopic assessment of the appendix is reliable , and to leave a normal-looking appendix at laparoscopy does not appear to cause any long-term problems AIM The aim of this study was to determine whether it is safe and cost-effective to discharge nonspecific abdominal pain ( NSAP ) patients from the Emergency Department ( ED ) and re-evaluate diagnosis later . METHODS Patients aged between 18 and 65 years were enrolled into the study . They had been admitted to the ED for acute abdominal pain with an indefinitive diagnosis after clinical examination and base-line investigations . The patients were r and omly assigned into two groups : 1 ) active clinical observation ( ACO ) , comprising those admitted to the ED  observation room ; 2 ) outpatient group ( OG )  , comprising those discharged and asked to return for re-evaluation at 8 - 12 hours intervals over the following three days . Each patient was examined by an ED physician and a consultant general surgeon . Demographics , blood tests , morbidity and mortality , number of operations , together with 6-month follow-up results were noted . Finally , a patient satisfaction question naire was administered . RESULTS A total of 105 patients were enrolled into the study ; 50 were r and omized to the ACO group and 55 to the OG . There were no statistically significant differences in demographics and blood parameters between the two groups . Overall agreement of ED diagnosis with final diagnosis was 91.4 % . Total morbidity was 10 % in the ACO group and 7.2 % in the OG . There were no statistically differences in morbidities and usage of diagnostic imaging modalities between the two groups ( P>0.05 ) . No deaths occurred in either group during the study period . The patients in the ACO group were more keen on returning for re-evaluation and willing to recommend our hospital services to other people ( P < or = 0.05 ) . CONCLUSION Outpatient evaluation of patients with an ED diagnosis of NSAP may be an option , seems to be safe , is not accompanied by an increased incidence of complications and is efficient if patients are selected properly INTRODUCTION The aim of the study is to analyse the own data and try to discuss if laparoscopic appendectomy offers any advantages in treating young women suffering from pain in right lower abfdominal quadrant . MATERIAL S AND METHODS The study was conducted on 148 patients admitted from October 1993 to December 1998 with diagnosis of of pain in right iliac fossa and operated on with a laparoscopic ( LA group : 75 cases ) or open approach ( OA group : 73 cases ) . Patients were prospect ively r and omized on the surgical approach adopted , following a r and omized list . RESULTS The operative time in LA group was significantly ( p < 0.001 ) longer ( 87.2 minutes ) than for OA group ( 65.2 minutes ) . In 2 patients ( 2.7 % ) the operation had to be converted . Diagnosis had remained unknown in 16 patients ( 21.9 % ) of OA group , in spite of only one case ( 1.4 % ) with laparoscopic technique . We did n't observed intraoperative complications . Pain in the first and second postoperative days , evaluated on the use of pain medication , was significantly less in patients in group LA ( p < 0.01 ) . There were no deaths . Postoperative complications occurred in 4 patients ( 5.5 % ) of group LA , and in 8 patients ( 10.9 % ) of group OA . Hospital stay was significantly shorter for those having laparoscopic appendectomy ( p < 0.001 ) . DISCUSSION The main advantages of laparoscopic appendectomy consist more in diagnostic accuracy , than in less postoperative pain , less hospital stay and less postoperative complications . CONCLUSION Laparoscopic appendectomy is a safe and accurate approach BACKGROUND Clinical diagnosis of acute appendicitis is most difficult in fertile-age women . In this patient group up to 50 % of open appendectomies are negative for appendicitis . We conducted a r and omized study to compare laparoscopic and open appendectomy in young female patients with suspected acute appendicitis . METHODS Fifty female patients between the ages of 16 and 40 years presenting with acute right lower abdominal pain were r and omized , 25 to laparoscopy and 25 to an open appendectomy .  Diagnostic accuracy , rate of negative appendectomies , safety , and final outcome were compared in the two groups . RESULTS Diagnosis was established in 96 % of patients in the laparoscopic group and in 72 % in the open group . There were 11 ( 44 % ) unnecessary appendectomies in the open group , but only one ( 4 % ) in the laparoscopic group ( p < 0.0005 ) . CONCLUSIONS In young women with right lower abdominal pain , laparoscopy can give precise diagnosis and reduce the rate of negative appendectomies The benefits of laparoscopic appendectomy appear to be controversial . Since 1994 , several abdominal procedures have been completed by using the needlescopic technique , but there appear to be no prospect i ve studies to demonstrate the perceived benefits of needlescopic appendectomy . The authors compared open , laparoscopic , and needlescopic appendectomy in a r and omized fashion with regard to duration of surgery , length of hospitalization , analgesic dosage , and surgery-associated complications . From March to July 1998 , 75 patients admitted at the emergency station of the authors ' hospital with a final diagnosis of acute appendicitis without tumor formation were r and omized to receive one of the three treatment categories : open ( OA ) , laparoscopic ( LA ) , and needlescopic ( nLA ) appendectomy . Laparoscopic and needlescopic appendectomy were performed by using a three-port technique , although the size of the trocar used varied . There were 26 patients in the OA group , 23 in the LA group , and 26 in the nLA group . The mean operation duration s for the OA , LA , and nLA groups were 55.4 ± 28.0 minutes , 69.1 ± 48.8 minutes , and 62.3 ± 26.3 minutes , respectively , and these were not significantly different from one another . The mean number of the analgesic doses ( Pethidine 1 mg/kg ) required was 1.3 ± 1.2 mg/kg , 0.5 ± 0.8 mg/kg , and 0.2 ± 0.6 mg/kg , respectively . Significant differences were noted when comparing the OA with the LA or nLA groups ( OA vs. LA , P = 0.02 ; OA vs. nLA , P = 0.0002 ; LA vs. nLA , P = 0.06 ) . The mean oral intake duration s were 32.2 ± 16.9 hours , 21.0 ± 14.6 hours , and 20.8 ± 16.4 hours , respectively , after surgery for the OA , LA , and nLA groups , and the between-group differences were statistically significant for the OA versus LA group ( P = 0.004 ) and for the OA versus nLA group ( P = 0.003 ) . The mean duration s of hospitalization for the OA , LA , and nLA groups were 3.6 ±1.8 days , 2.8 ± 1.4 days , and 2.4 ± 0.9 days , and difference was detected between the OA and the nLA groups ( P = 0.02 ) . The OA group rendered a greater wound-complication rate and ileus than did the other two groups , but the differences were not detected between the three categories ( P = 0.065 , 0.6935 ) . The result of the current study confirmed that the nLA procedure is a feasible and safe one . The nLA procedure provided substantial advantages over the OA procedure in the context s of diminished postoperative pain and shorter hospital stay without significant increases in postoperative complication rate or surgical time BACKGROUND Laparoscopic appendectomy is feasible , but whether it confers any advantage to patients with acute appendicitis is not known . We performed a r and omized controlled trial to compare results of laparoscopic and open appendectomy in patients with signs and symptoms suggesting acute appendicitis who were seen by one surgical team . METHODS Sixty-two consecutive patients were r and omized , 30 to laparoscopy and 32 to a classical open appendectomy .  Postoperative recovery , complications , and return to normal activities were compared in the two groups . RESULTS The laparoscopy group were discharged earlier ( 2.5 vs 3.8 days , p less than 0.01 ) . Postoperative complications were more frequent after open appendectomy . Follow-up showed less pain , shorter bed stay at home , and faster return to work and sport after laparoscopic appendectomy . CONCLUSIONS This prospect i ve r and omized study shows that laparoscopic appendectomy is superior to open appendectomy in terms of hospital stay , postoperative complications , and return to normal activities and is recommended as the approach of choice in the management of acute appendicitis Background The aim of this study was to study the value of diagnostic laparoscopy prospect ively in fertile women scheduled for acute appendectomy . Methods For this study , 110 women , with acute abdominal pain ages 15 to 47 years , in whom the surgeon had decided to perform an appendectomy  , were r and omized to either open appendectomy or diagnostic laparoscopy , then open appendectomy if necessary . Results Appendicitis was diagnosed in 66 % of the women after open surgery , and in 73 % after laparoscopy . During laparoscopy , was appendicitis misdiagnosed in only 7 % of the women , from whom the appendix unnecessarily removed , whereas 34 % in the open surgery group had a healthy appendix removed . No appendicitis was missed in the laparoscopic group . The relative risk of removing a healthy appendix in open surgery was 6.6 relative risk ( range , 2–21 C.I. ) as compared with laparoscopy . Among the women with a healthy appendix , a gynecologic diagnosis was found in 73 % after laparoscopy , as compared with 17 % after open surgery . Conclusions Laparoscopy reduces unnecessary appendectomies and improves diagnosis in fertile women Laparoscopy in patients with a clinical suspicion of acute appendicitis has not gained wide acceptance , and its use remains controversial Background The role of laparoscopy in the management of patients with suspected acute appendicitis remains controversial . It has been suggested that laparoscopy is useful mainly in young women of reproductive age because of the high incidence of wrong diagnosis in these patients . Methods Different management protocol s for patients with suspected acute appendicitis were prospect ively used in 
    Output:
    
Data suggest that EL performs better in establishing a final diagnosis after admission , but the lack of uniform information does not allow for the recommendation of EL as a routine strategy in clinical practice .