In this prospective randomized double-blinded trial, laparoscopic appendectomy appears to confer no significant advantage over open appendectomy for postoperative pain or lost work days. It does carry an increase in operating room costs and, contrary to other reports, hospital stay is not shortened. Further studies are needed to determine if specific populations, such as the obese or women, may benefit from a minimally invasive approach to appendicitis.

This study did not demonstrate a reduction in postoperative pain or a consistent improvement in recovery when the port size was reduced at the subcostal and subxiphoid positions. It did, however, show that ports could safely be reduced in size without a negative impact on the surgeon's ability to perform a cholecystectomy. Reducing port size can be a tool in the surgeon's armamentarium for use in the attempt to optimize cosmetic results.

Both approaches resolved reflux symptoms without significant differences in complications, conversions, or length of stay. Preoperative differences between groups, as well as the method of sequentially comparing the two different procedures, prevent us from attributing greater postoperative dysphagia in the Rossetti group solely to the choice of surgical approach. Prospective randomized studies are needed to control for variables, such as surgical team experience and patient differences.

A variety of intraoperative complications associated with laparoscopic fundoplication have been reported, including gastric, esophageal, and bowel perforations, cardiac tamponade, pneumothorax, celiac artery thrombosis, bleeding, and death. Although this is the first reported aortic injury during minimally invasive fundoplication not related to trocar placement, discussion with other surgeons indicates that this is not the only occurrence of this complication.

We conclude that, in addition to minimizing port size and number, positioning of ports can be used to optimize cosmetic results.