A Clinical Comparison of Laparoscopic versus Open Appendectomy for Complicated Appendicitis

Abstract

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.

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

“…It is plausible that LA for perforated appendicitis should result in a decreased incidence of IAA because the abdominal cavity can be better visualized and a more thorough washout can be performed. However, a higher incidence of IAA formation following the use of laparoscopy has been reported [5,11,15], which possibly has hampered LA being adopted as a standard procedure for CA. 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.…”

“…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].…”

“…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.…”

Open versus laparoscopic appendicectomy in acute appendicitis: results of a District General Hospital

“…6 Due to prolonged overall surgery duration, high incidence of postoperative IAA and rate of conversion to OA, there is doubt as to the suitability of laparoscopy in complicated appendicitis, which requires advanced laparoscopic skills. 7,8 Despite wide experience of many centres and multiple prospective and retrospective studies, the advantages of LA compared to OA are still either unclear 9,10 or of limited clinical relevance 8 and have prevented LA from completely replacing OA and being advocated as the procedure of choice for appendicectomy. The aim of the current study was to compare the results of open and laparoscopic appendicectomies with regards to safety at a district general hospital.…”