Perforated Appendicitis: Is Laparoscopic Operation Advisable?

Abstract

Aims: A retrospective study was used to compare laparoscopic appendectomy for perforated appendicitis to open operation. Methods: Between July 1991 and June 1999 a total of 734 patients, all over 14 years of age, underwent operation for acute appendicitis. Of these patients, 125 (17%) displayed perforated appendicitis and were treated with either a laparoscopic appendectomy (n = 80; total conversion rate 36/80, 45%) or a primary open procedure (n = 45). Results: Due to selection, the 3 treatment groups (laparoscopic, laparoscopy with conversion, open operation) showed differences with respect to gender, duration of symptoms, proportion of obese patients and patients with generalized peritonitis. The median operating time was 75 min for the laparoscopic procedure, 90 min for a converted procedure and 70 min for open operation. Only 1 of 44 (2%) patients who had a laparoscopic operation, but 8 of 36 (22%) who had a converted operation, and 8 of 45 (18%) who had an open operation developed wound infection. A similar frequency of intra-abdominal abscess formation was observed in the 3 treatment groups (2/44, 5%; 3/36, 8%; 2/45, 5%). Fatal outcome occurred only in patients who underwent an open operation and presented with severe peritonitis (5/45, 11%). Conclusions: Despite limitations in comparability of patient groups, laparoscopic appendectomy was associated with a significantly lower rate of septic wound complications (p < 0.05). This was especially true for the subgroup of obese patients (BMI >26). Therefore, for patients with perityphlitic abscess or fresh purulent lower abdominal peritonitis, but not for patients with generalized peritonitis, laparoscopic appendectomy is not only justifiable but even recommended as the procedure of choice.

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

“…Two 93-year-old women died of systemic sepsis with multiple organ failure, while one 80-year-old man died of pneumonia. These results are in agreement with previous reports and highlight the fact that surgery for perforated appendicitis remains a potentially high-risk operation with a nonnegligible mortality rate [20][21][22][23].…”

Management of childhood appendicitis: laparoscopic versus open approach Çocuklarda laparoskopik ve açık apendektomi sonuçlarının karşılaştırılması

“…On the other hand, eight patients who underwent open appendectomy for appendicitis developed a superficial wound infection. These results were comparable to other published infection rates (12,17).…”

“…However there have been several studies suggesting that the laparoscopic approach results in possible increased length of operating time and postoperative complications compared to the open approach. These observations have been reported in both adults and children (5)(6)(7)(8)(9)(10)(11)(12).…”

“…There have been several reports suggesting the hospitalization was significantly shorter when the patient treated by laparoscopic appendectomy (12,(14)(15)(16)25). The mean length of stay for the laparoscopic appendectomy group in the present series was almost 24 hours less than that for the open appendectomy group (p<0.05).…”

Is there is a role for laparoscopy for treatment of appendicular mass?

“…The median duration of preoperative hospital stay in the 8 patients was 1 day (range, 0-3); mean duration of preoperative symptoms was 5 days (range, [3][4][5][6][7][8][9][10][11][12][13][14][15]. Postoperative antibiotics were given for 24 h in patients without abscess formation and for 48-72 h in the patient with appendicular abscess.…”