Laparoscopic Versus Open for Complicated Appendicitis

ABSTRACT

BACKGROUND: For complicated appendicitis, in contrast to simple appendicitis, laparoscopic appendectomy (LA) is considered a relative or absolute contraindication because of the higher postoperative complication rate than that of open appendectomy (OA), especially, high incidence of intra-abdominal abscess. The purpose of this article is to assess the feasibility of LA for complicated appendicitis. METHODS: A retrospective review of 35 LA and 128 OA for the cases of gangrenous, perforated appendicitis, and periappendiceal abscess between May 1995 and June 1997 was performed. Patients were identified through the hospital pathology registry. We compared data from both groups with respect to operative times, postoperative pain, duration of ileus, length of hospital stay, and complication rate, with special attention to the incidence of intra-abdominal abscess. RESULTS: 1) The malefemale ratio of LA (11.2) was significantly lower than that of OA (10.45) (p0.05). But LA was associated with higher incidence of postoperative intra-abdominal abscess (3/35, 8.6%) than OA (3/128, 2.3%) (p=0.114). There was one serious intra-abdominal abscess in the LA, which required reoperation. The rest 2 cases in the LA and all 3 cases in the OA were treated conservatively. CONCLUSIONS: LA for complicated appendicitis could afford the merits of shorter hospital stay, reduced incidenceof wound infection, and comparable incidence of overall complication rate. To reduce the incidence of postoperative intra-abdominal abscess, copious irrigation and adequate drainage should be recommended.