Laparoscopic approach in perforated appendicitis: increased incidence of surgical site infection?

Abstract

Background The role of laparoscopy in the setting of perforated appendicitis remains controversial. A retrospective study was conducted to evaluate the early postoperative outcomes of laparoscopic appendectomy (LA) compared to open appendectomy (OA) in patients with perforated appendicitis. Methods A total of 1,032 patients required an appendectomy between January 2005 and December 2009. Among these patients, 169 presented with perforated appendicitis. Operation times, length of hospital stay, overall complication rates within 30 days, and surgical site infection (SSI) rates were analyzed. Results Out of the 169 evaluated patients, 106 required LA and 63 OA. Although operation times were similar in both groups (92 ± 31 min for LA vs. 98 ± 45 for OA, p = 0.338), length of hospital stay was shorter in the LA group (6.9 ± 3.8 days vs. 11.5 ± 9.2, p \ 0.001). Overall complication rates were significantly lower in the LA group (32.1 vs. 52.4 %, p \ 0.001), as were incisional SSI (1.9 vs. 22.2 %, p \ 0.001). Organ/space SSI rates were similar in both groups (23.6 % after LA vs. 20.6 % after OA, p = 0.657). Conclusions For perforated appendicitis, LA results in a significantly shorter hospital stay, fewer overall postoperative complications, and fewer wound infections compared to OA. Organ/space SSI rates were similar for both procedures. LA provides a safe option for treating patients with perforated appendicitis.Keywords Adult Á Laparoscopy Á Organ space infection Á Perforated appendicitis Appendicitis is one of the most common causes for emergency abdominal surgery, with a reported lifetime incidence of approximately 7 % [1]. Laparoscopic appendectomy (LA) has gradually become a routine procedure, although its efficacy and superiority remain a matter of debate. Several reports suggest that LA provides advantages in terms of shorter hospital stay, less postoperative pain, faster recovery time, and reduced morbidity rate at the expense of longer operating times [2][3][4][5]. However, other studies reported no significant advantages for LA compared to open appendectomy (OA), stating that choice of the operative approach should be based on surgeon and patient preference [6,7].One of the main controversies lies within the application of LA in the setting of perforation. Perforated appendicitis is inevitably associated with higher postoperative morbidity and mortality rates [8], with one of the most feared postoperative complications being an intra-abdominal abscess. Previous studies have demonstrated that LA for complicated appendicitis may be associated with an increased rate of abscess formation when compared to OA, suggesting caution when using the laparoscopic approach in this group of patients [9][10][11][12].

Laparoscopic versus open surgery for complicated appendicitis in adults: a randomized controlled trial

“…Our findings showed that the rates of organ/space SSI, with or without stump leakage, were similar between the study groups, with a comparable incidence of reoperation and IVR. These results are consistent with recent retrospective studies [1,3,7,8,10,14], and, therefore, LA for CA is considered safe and feasible with improvements in techniques and devices. Nonetheless, the roles of extensive irrigation and routine drainage to reduce risks of IAA that were employed in this study remain debatable [22][23][24][25][26].…”

“…The surgical management of CA generally requires a larger abdominal incision and longer operating time, with increased surgical stress to patients, compared Values are mean ± SD with surgery for uncomplicated appendicitis. The effectiveness of the laparoscopic approach for CA has been extensively studied [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. However, the role of laparoscopy in CA is still undefined due to lack of high-level evidence (e.g., randomized controlled trials).…”

“…On the other hand, postoperative intraabdominal abscess (IAA) remains a major concern in LA for perforated appendicitis. Indeed, the reported rate of postoperative IAAs diverges widely in different studies comparing LA versus open appendectomy (OA) for CA [1][2][3][5][6][7][8][9][10][11][12][13][14][15].These previous retrospective reports provide the initial framework for higher-level studies on LA versus OA for CA, and randomized controlled trials evaluating the laparoscopic approach for CA are warranted [16]. We designed this randomized controlled study to investigate whether LA for CA effectively reduces the incidence of postoperative complications and improves various measurements of postoperative recovery in adults compared with OA.…”

“…On the other hand, postoperative intraabdominal abscess (IAA) remains a major concern in LA for perforated appendicitis. Indeed, the reported rate of postoperative IAAs diverges widely in different studies comparing LA versus open appendectomy (OA) for CA [1][2][3][5][6][7][8][9][10][11][12][13][14][15].…”

Surgical Wound Infections After Laparoscopic Appendectomy With or Without Using Reusable Retrieval Bag: A Retrospective Study

“…Several studies have shown the advantages of laparoscopic surgery in terms of shorter hospital stay, rapid postoperative recovery, and better pain control (10)(11)(12)(13). However, there have been concerns about the risk of infectious complications, particularly the development of intra-abdominal abscess and superficial wound infection (14,15). With occurring these complications, all laparoscopic advantages will be lost.…”