Laparoscopic Versus Open Appendectomy for Perforated Appendicitis

Lin, Heng-Fu; Wu, Jiann‐Ming; Tseng, Li-Ming; Chen, Kuo-Hsin; Huang, Shih-Horng; Lai, I-Rue

doi:10.1016/j.gassur.2005.12.012

Cited by 79 publications

(66 citation statements)

References 24 publications

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“…The significantly higher rate of incisional SSI in OA compared to LA is explained by the increased wound surface area, which is in potential contact with the infected fluids. Previous studies have shown similar wound infection rates [18,19]. The smaller incisions associated with the laparoscopic approach, combined with the use of a retrieval plastic bag to remove the appendix, greatly reduce the risk of local wound contamination.…”

Section: Discussionmentioning

confidence: 86%

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

et al. 2013

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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].

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Section: Discussionmentioning

confidence: 86%

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

et al. 2013

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“…The laparoscopic appendectomy, first described by Semm in 1983 (28), appears to have considerable advantages comparing to a conventional appendicectomy; this approach reduces tissue damage and therefore reduces the risk of potential postoperative adhesion by reducing intestinal stimulation, determines less hospital stay, less pain, earlier ambulation and oral nutrition, better aesthetic results and less risk of surgical wound infection. Also in case of appendicular perforation, as in the case reported, it enables us to assess any damage to other abdominal organs (29). In our case, the discovery of the toothpick that perforated the appendix and pierced the liver was very surprising.…”

Section: Discussionmentioning

confidence: 51%

A rare case of perforation of the subhepatic appendix by a toothpick in a patient with intestinal malrotation: laparoscopic approach

Grassi¹

2016

GCHIR

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Acute appendicitis is one of the most common surgical diseases presented by patients in the emergency unit, it affects about 7% of the Western population, the mortality rate is estimated to be around 0.2-0.4% (1). Typical presentation is represented by periumbilical pain radiating to the right lower quadrant of the abdomen with peritoneal reaction on palpation, fever and anorexia. However atypical clinical presentations have been reported such as back pain, pain in the lower quadrants of the abdomen (2) especially in the case of situs inverus (3), pain in the left flank or in the left hypochondrium, in the case of intestinal malrotation (4). Appendicitis results from infection (60%), coprolites (35%), parasites (3%), strictures and tumors (1%) and foreign bodies. Acute appendicitis due to the ingestion of foreign bodies is a rare event, but widely described in the literature. Klinger et al. reported that ingested foreign bodies account for the 0.0005% of the aetiology of acute appendicitis (5). Complications related to the ingestion of foreign bodies are obstruction, perforation, hemorrhage, and fistula. The majority of the ingested foreign bodies pass through the esophagus and through the gastrointestinal tract without complications, however, the risk of perforation increases when long and sharp objects, such as toothpicks, are ingested (6). This case report is extremely interesting both for the peculiarity and rarity of the disease and for the therapeutic approach chosen. Case presentationA 65-year-old man was admitted under emergency to the Department of Digestive Surgery and Liver Unit, St. M. Hospital, Terni, with a 2 days history of lower abdominal pain and fever.Physical examination revealed generalized tenderness and rigidity of the abdominal walls especially in the right hypochondrium with torpid peristalsis. Laboratory blood analysis were in the range, including hepatic function; a neutrophilic leukocytosis was present. Abdomen ultrasound revealed the gallbladder and bile duct within limits without gallstones, a subhepatic cecum without SUMMARY: A rare case of perforation of the subhepatic appendix by a toothpick in a patient with intestinal malrotation: laparoscopic approach.

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“…18,19 On the other hand, Yau et al 20 reported that LA group had a shorter operative time (i.e., 55 minutes in the LA group and 70 minutes in the OA group; P < 0.001). Park and Sul 21,22,23 reported the same result and explained that the LA had a better surgical filed view that ultimately helped to detect adhesions or abscesses the conventional OA; this might contributed to the shorter operating time and the fewer postoperative complications.…”

Section: Discussionmentioning

confidence: 72%

Complicated Appendicitis; To Compare Laparoscopic Appendectomy and Open Appendectomy as Treatment of Complicated Appendicitis

Shuja

Ramzan

Sharif

2017

TPMJ

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ABSTRACT… Appendectomy is the most common surgical procedure performed in surgical emergency. The advent of minimal invasive surgery has massively influenced the field of surgery. Laparoscopic surgery might offer clinical benefits in perforated and complicated appendicitis. Objective: To compare laparoscopic appendectomy and open appendectomy as treatment of complicated appendicitis in terms of mean requirement of post-operative analgesia, operative time and hospital stay. Study design: Randomized control trial. Setting: All subjects for the study were recruited from Department of Surgery, Independent University Hospital, Faisalabad. Duration: The duration of study was of 6 months duration from February 2012 to august 2012. Results: In this study the divided into two groups, group A for open appendectomy (OA) and group B for Laparoscopic Appendectomy (LA). Both groups had 43 patients each. The operating time for open appendectomy group A had mean operating time 37.21 minutes .The hospital stay in OA group was 2.63 days. The mean dosage of analgesia requirement was 258 mg of diclofenac. The operating time for open appendectomy group A had mean operating time 39.16 minutes. The hospital stay in OA group was 2.95 days. The mean dosage of was 258.14 mg of diclofenac. Conclusion: Our study concludes that both approaches laparoscopic and open approach have proved to be similar in terms of post-operative hospital stay, operating time and analgesia requirement. Where as LA is superior in terms of cosmesis and surgical site infection. Further studies with more number of patients are recommended to asscess the benefits of laparoscopic approach in complicated appendicitis.

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Laparoscopic Versus Open Appendectomy for Perforated Appendicitis

Cited by 79 publications

References 24 publications

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

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

A rare case of perforation of the subhepatic appendix by a toothpick in a patient with intestinal malrotation: laparoscopic approach

Complicated Appendicitis; To Compare Laparoscopic Appendectomy and Open Appendectomy as Treatment of Complicated Appendicitis

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