Laparoscopic or Open Appendectomy: Which Approach is the Best for Complicated Appendicitis?

Abstract

Introduction: Appendicitis is more common in children and young adults. Treatment of appendicitis is either laparoscopic appendicectomy (LA) or open appendicectomy (OA) surgery. Aim and objective: The 30-day postoperative morbidity, surgical site infection, and reoperation rate were compared between open and laparoscopic appendicectomies for complicated appendicitis. Secondary outcome measures were the length of hospital stay, duration of surgery, surgical waiting time, identification of other diseases, and patient satisfaction. Materials and methods: This retrospective study was conducted in two institutions: Hospital Selayang, Selangor, Malaysia, and HUKM, Kuala Lumpur, Malaysia. Data were collected from January 2014 to December 2015 were reviewed. Results: The mean age (±SD) for LA and OA were 32 (±15) and 30 (±14) years, respectively. The males showed predominance in LA and OA with 52 and 72%, respectively (p < 0.001). The majority of LA (73%) and OA (88%) were performed by the trainees (p < 0.001). There was a significant reduction in postoperative morbidity in LA compared to OA in terms of surgical site infection, LA vs OA [n = 8 (2.7) vs 26 (6.3), p = 0.029] and duration of surgery [LA vs OA 84 (±39) vs 68 (± 6) days (p < 0.001)]. However, for LA and OA, there were no significant differences in reoperation, 0.7 and 1.0%, respectively (p = 1.000), and length of stay in LA vs OA 3.55 (±2) vs 3.89 (±3) days, respectively (p = 0.103). Overall, patient satisfaction scores were not found statistically significant as the response rates were only 32% in LA and 30% in OA. Conclusion: LA significantly reduced surgical site infection and offered an advantage in the detection of other pathologies. Hence, a laparoscopic approach should be offered to patients whose clinical diagnoses are challenging.

Evaluation of the Outcome of Right Subumbilical Transverse Incision Approach for the Management of Complicated Appendicitis in Paediatric Age Group – A Multi-Institutional Retrospective Study

“…There were no intra-abdominal abscess or faecal fistula in our patients as reported by other authors,[ 16 20 23 ] which again could be attributed to excellent exposure of RIF, the pelvis, the paracolic gutter and the subhepatic regions, as a result, all loculated collections could be dealt with easily without much tissue handling.…”

“…The average operative time in our study was 1 h 48 min which appears to be slightly more than what has been reported by other studies,[ 17 23 ] which could be attributed to more time spent in wound closure as interrupted sutures were used. The time spent in actual dissection was less due to excellent exposure of the structures.…”

“…The average hospital stay in our study was 9 days which is also more than what has been reported in other studies. [ 23 ] This is because we follow a protocol of giving bowel rest of 4–5 days to all patients who had features of peritonitis at the time of surgery, to allow ileus and bowel oedema to resolve before starting enteral nutrition. We look forward to decrease this duration in our subsequent cases.…”

Laparoscopic Versus Open Appendicectomy in the Management of Complicated Appendicitis

“…These results were comparable to a study done by Jailani et al where the mean age (±SD) for LA and OA were 32 (±15) and 30 (±14) years respectively and also comparable to a multicenter prospective observational study by Yeh et al where median age was 37 (27-52) years. (11,12) The study comprised 35 males (58.3%) and 25 females (41.7%). This co-relates with most of the literature noting slight male predominance.…”