Laparoscopic appendectomy in complicated appendicitis: Is it safe?

Abstract

BACKGROUND:Because of lack of good evidence supporting laparoscopic approach for complicated appendicitis, we carried out this study to evaluate efficacy of laparoscopic appendectomy (LA) in management of patients with complicated appendicitis.MATERIALS AND METHODS:This study was carried out in Surgical Department, Minia University, Egypt involving 214 patients underwent appendectomy for complicated appendicitis over three years. 132 patients underwent LA and remaining 82 patients underwent OA. Parameters studied included operating time, return to oral feeding, postoperative pain, wound infection, intra-abdominal abscess, duration of abdominal drainage and hospital stay.RESULTS:There were four conversions, two due to extensive cecal adhesions and two due to friable appendix. LA took longer time to perform (p = 0.0002) but with less use of analgesics (p < 0.0001), shorter hospital stay (p < 0.0001), shorter duration of abdominal drainage (p < 0.0001) and lower incidence of wound infection (p = 0.0005). Nine patients in LA and seven patients in OA group developed intra-abdominal abscess treated successfully with sonographic guided percutaneous drainage. Postoperative ileus was recorded in two patients in LA group and three patients in OA group, chest infection in one patient in OA group, hernia in one patient in LA and fecal fistula was present in one patient in OA. Overall complications were significantly lower in laparoscopy group and managed conservatively with no mortality in either group.CONCLUSIONS:LA in complicated appendicitis is feasible and safe with lower incidence of complications than OA and should be the initial choice for all patients with complicated appendicitis.

Laparoscopic Versus Open Appendectomy for the Treatment of Complicated Acute Appendicitis

“…This may be due to the need for peritoneal lavage and the need for a tying of base in the laparoscopic procedure (17)(18)(19)(20)(21)(22).Despite this finding, to the detriment of the laparoscopic method, the median length of hospitalization (85.2 hours vs. 98.6 hours) and the mean severity of postoperative pain (6.3 vs. 7.2) were significantly shorter compared to open surgery. We found that the results of a study done by Mohamed and Mahran (2013), on 133 patients with complicated acute appendicitis in the laparoscopic surgery group and 82 patients with complicated acute appendicitis in the open surgery group are correlate with the findings of our study that postoperative analgesia and the average duration of hospitalization after surgery in the open surgery group is significantly more (5). In another study by Garg et al (2009) on patients with complicated acute appendicitis who go under open surgery (61 patients) or laparoscopic surgery (49 patients) the postoperative pain severity and average hospitalization (3 day 6 versus day 1) was significantly higher in the first group (23).…”

“…The mean duration of hospitalization in the laparoscopic appendectomy group was 85.2 ±11.4 hours (60-110) and in the open appendectomy group was 98.6 ±18.1 hours (60-168) (p <0.001). Mean pain score in laparoscopic appendectomy group was 6.3±1.7 (3)(4)(5)(6)(7)(8)(9) and in open appendectomy group was 7.2±1.6 (3-9) (p <0.001).…”

“…Finally, it has been shown that the sundry effects are more common in the open surgical group (29). In a study by Mohamed and Mahran (2013), on patients with complicated acute appendicitis undergoing open or laparoscopic surgery it was reported that incidence of wound infection and sundry effects is more in the open surgery group (5). In other studies, there were no statistically significant differences in the incidence of postoperative sundry effects in the two groups (23,24,30).…”

Laparoscopic appendectomy for perforated appendicitis in children: Is intraperitoneal drainage necessary?

“…Perforated appendicitis in childhood occurs mostly due to the delays in hospital admission and improper management of abdominal pain. Open surgery is a well-accepted procedure for the management of appendicitis [8]. However, with the increased experience of the surgeons on minimally invasive techniques, appendectomy can be performed laparoscopically in perforated appendicitis cases as well [9].…”

Single Incision versus Conventional Multiport Laparoscopic Appendectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Conventional multiport laparoscopic appendectomy (CMLA) has gained broad acceptance among general surgeons because of several advantages, such as smaller incision, reduced postoperative pain, less wound infection, more rapid recovery and better cosmetic result when compared with open appendectomy (OA), for both uncomplicated and complicated appendicitis, across the most illness severity groups [1,2,3]. Therefore, CMLA is recommended as the preferred technique for acute appendicitis.…”