Laparoscopic Versus Open Appendectomy in Complicated Appendicitis: A Review of the NSQIP Database

Tuggle, K.R.; Ortega, Gezzer; Bolorunduro, Oluwaseyi; Oyetunji, Tolulope A.; Richard, Alexander; Turner, Patricia L.; Chang, David C.; Cornwell, Edward E.; Fullum, Terrence M.

doi:10.1016/j.jss.2010.03.071

Cited by 68 publications

(12 citation statements)

References 18 publications

(21 reference statements)

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“…In our study, there was no significant difference in the incidence of abscess formation between LA and OA, and this is similar to another report 16. Tuggle et al provided evidence from a nationwide study showing that, in cases of complicated appendicitis, LA is superior in terms of superficial and deep wound infections; in contrast to our results, LA was associated with an increased incidence of postoperative IAA 11. Markides et al reported that LA has advantages in terms of less SSI compared to OA in complicated acute appendicitis, and (in agreement with our results), there was no significant additional risk of IAA 17.…”

Section: Discussionsupporting

confidence: 91%

Risk factors of converting to laparotomy in laparoscopic appendectomy for acute appendicitis

Abe¹,

Nagaie²,

Miyazaki³

et al. 2013

CEG

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PurposeLaparoscopic appendectomy (LA) for acute appendicitis has several advantages over open appendectomy (OA). In cases of complicated appendicitis, LA is converted to OA at a constant rate, though converting appendectomy (CA) has several disadvantages. We retrospectively determined preoperative risk factors for failure of LA and subsequent conversion to OA.MethodsConsecutive cases of preoperative computed tomography (CT) and attempted LA were retrieved from our hospital database and grouped by procedure (LA versus CA). Patients with negative appendectomies (n = 28), opened appendectomy (n = 210), delayed interval appendectomy (n = 3), or who were <14 years of age were excluded.ResultsAverage patient age, preoperative C-reactive protein (CRP) level, and diffuse peritonitis were significantly different between the groups. CT inflammation and occurrence of complicated appendicitis were significantly higher in CA than LA. Conversion to OA was mostly because of dense adhesions, diffuse peritonitis, and difficulties in excision of the appendix due to perforation or severe inflammation from surgical point of view. Postoperative complications were significantly lower in LA than CA, although the rate of intraoperative abscess was not different.ConclusionMost patients with acute appendicitis can be successfully treated with LA. We identified the following significant risk factors of CA: CT inflammation grade 4 or 5; complicated appendicitis; higher preoperative CRP level; and diffuse peritonitis.

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Section: Discussionsupporting

confidence: 91%

Risk factors of converting to laparotomy in laparoscopic appendectomy for acute appendicitis

Abe¹,

Nagaie²,

Miyazaki³

et al. 2013

CEG

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“…With regard to postoperative period of hospitalization, the super-elderly group 13.86 ± 8.92 days in the hospital while the elderly group spent 9.78 ± 5.02 days, a statistically significant difference (P = 0.001). Compared with the results of previous studies [17, 18], the super-elderly group in the present study showed a longer hospital stay. The reason is thought to be related to the desire of elderly patients to remain in the hospital long enough for the surgical wound to heal.…”

Section: Discussioncontrasting

confidence: 93%

Clinical Characteristics and Surgical Safety in Patients with Acute Appendicitis Aged over 80

Moon

Jung

Lee

et al. 2012

J Korean Soc Coloproctol

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PurposeThe aim of this study was to evaluate the clinical characteristics and treatment outcomes, including surgical safety, in patients over 80 years of age who underwent an appendectomy.MethodsThis study involved 160 elderly patients who underwent an appendectomy for acute appendicitis: 28 patients over 80 years old and 132 patients between 65 and 79 years old.ResultsThe rate of positive rebound tenderness was significantly higher in the over 80 group (P = 0.002). Comparisons of comorbidity, diagnostic tool and delay in surgical treatment between the two groups were not statistically different. American Society of Anesthesiologists score was significantly higher in the over 80 group than in the 65 to 79 group (2.4 ± 0.5 vs. 1.6 ± 0.5; P < 0.00005). Comparisons of operative times and use of drainage between the two groups were not statistically different. In the pathologic findings, periappendiceal abscess was more frequent in the over 80 group (P = 0.011). No significant differences existed between the two groups when comparing the results of gas out and the time to liquid diet, but the postoperative hospital stay was significantly longer in the over 80 group (P = 0.001). Among the postoperative complications, pulmonary complication was significantly higher in the over 80 group (P = 0.005). However, operative mortality was zero in each group.ConclusionIn case of suspicious appendicitis in elderly patients, efforts should be made to use aggressive diagnostic intervention, do appropriate surgery and prevent pulmonary complications especially in patients over 80 years of age.

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“…Tuggle et al [22] analyzed National Surgical Quality Improvement Program (NSQIP) to evaluate the length of hospital stay, and it showed statistical significance (4.0 days in the LA group and 5.1 days in the OA group). Khiria et al [23] evaluated the length of hospital stay for CA and reported a statistical difference between the two groups (5 days in the LA group and 9 days in the OA group).…”

Section: Discussionmentioning

confidence: 99%

A Clinical Comparison of Laparoscopic versus Open Appendectomy for Complicated Appendicitis

Lim

Ahn

Kim

et al. 2011

J Korean Soc Coloproctol

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PurposeAlthough laparoscopic appendectomies (LAs) are performed universally, a controversy still exists whether the LA is an appropriate surgical approach to complicated appendicitis (CA). We retrospectively evaluated the outcomes of laparoscopic versus open appendectomies for CA.MethodsWe retrospectively analyzed 60 consecutive patients who were diagnosed as having CA from July 2009 to January 2011. Outcomes such as operative time, time to soft diet, length of hospital stay, and postoperative complications were analyzed.ResultsThere were no statistically significant differences in operative time between the LA and the open appendectomy (OA) groups. Return to soft diet was faster in the LA group (2.1 ± 1.2 vs. 3.5 ± 1.5 days; P = 0.001). Length of hospital stay was shorter for the LA group (4.4 ± 2.3 vs. 5.8 ± 2.9 days; P = 0.045). The overall complication rates showed no statistically significant difference between the two groups. In cases involving a periappendiceal abscess, the LA had a significantly higher incidence of intra-abdominal abscess (IAA) and postoperative ileus (PI; P = 0.028).ConclusionThe LA showed good results in terms of the time to soft diet, the length of hospital stay, and surgical site infection (SSI) whereas the overall complication rates were similar for the two groups. However, the LA was associated with significantly higher incidence of IAA and PI for the cases with a periappendiceal abscess. Therefore, when using a LA, the surgeon must take great care to minimize the incidence of IAA and PI if a periappendiceal abscess is present.

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Laparoscopic Versus Open Appendectomy in Complicated Appendicitis: A Review of the NSQIP Database

Cited by 68 publications

References 18 publications

Risk factors of converting to laparotomy in laparoscopic appendectomy for acute appendicitis

Risk factors of converting to laparotomy in laparoscopic appendectomy for acute appendicitis

Clinical Characteristics and Surgical Safety in Patients with Acute Appendicitis Aged over 80

A Clinical Comparison of Laparoscopic versus Open Appendectomy for Complicated Appendicitis

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