Background: Laparoscopic appendectomy (LA) is associated with less postoperative pain and earlier return to normal activity. However its role in the management of complicated appendicitis remains undefined and the choice of the operative approach is mostly at surgeon's discretion. In this prospective study we compared the laparoscopic and the open approaches in terms of safety and efficacy for complicated appendicitis. Patients and
Methods: Consecutive patients who underwent appendectomy for acute appendicitis from January 2003 to November 2007 at our teaching Institution were studied. Patient’s data including demographics, operative time, short term complications (including surgical site infections-SSI), length of stay and access-related longer-term complications (small bowel obstruction, incisional hernia) were prospectively recorded and entered in a database. Data from patients who underwent OA or LA for complicated appendicitis were compared. These data were also matched with OA or LA for uncomplicated appendicitis (controls). Complicated appendicitis was defined as gangrenous or perforated appendicitis with or without the presence of abscess. Exclusion criteria were: age <14 years, patients presenting with generalized peritonitis or patients requiring additional surgery to appendectomy. Student’s t-test, Mann-Whitney U test and the Fisher exact test were used for statistical analysis.
Results: A total of 260 patients (124 M, 136 F, mean age 29+/-12 years) underwent appendectomy during the study period. Eighty-two (31.5%) were complicated appendicititis: 38 patients underwent open appendectomy (OA) while 44 underwent LA. Conversion rate to OA complicated appendicitis rate was significantly increased compared to uncomplicated (15.4% vs 2.2%; p<0.003). No significant differences were observed in terms of mean operative time or length of stay between OA and LA for complicated appendicitis and results were similar to OA and LA performed for uncomplicated controls. Overall complication rate was higher (but not significant) after OA compared to LA for complicated appendicitis (7.9% vs 4.5%). Both rates were also similar to uncomplicated controls. Overall incidence of SSI was 3.1% and infections were equally distributed between groups (complicated vs uncomplicated: 2.4% vs 3.4%; OA vs LA: 4.5% vs 2.2%). One patient of OA group experienced incisional hernia.
Conclusions: complicated appendicitis is associated with an increased need of conversion to open technique. However this study failed to show significant differences between LA and OA performed for complicated appendicitis.