Laparoscopic Appendectomy: A Safe Primary Procedure for Complicated Appendicitis

Park, Jun Beom; Sul, Ji Young

Abstract

PURPOSE: We performed a study comparing the morbidity of laparoscopic and open appendectomy to assess whether laparoscopic appendectomy could be an initial procedure of choice for patients suffering with complicated appendicitis (gangrene, perforation and periappendiceal abscess).
METHODS
We studied the patients who underwent appendectomy by either a laparoscopic or an open technique at Chungnam National University Hospital between January 2003 and July 2006. There were 118 patients in the laparoscopic appendectomy (LA) group and 232 patients in the open appendectomy (OA) group.
RESULTS
The operating times and length of hospital stay were significantly shorter for the LA group than for the OA group (P < 0.05). Five patients (4.2 %) underwent conversion from LA to OA, but none of these patients showed more of a propensity for complications compared with the OA group. 51 of the 350 patients (14.6 %) had 67 postoperative complications, including wound infection, intraabdominal abscess, ileus ( > 72 hours) and small bowel obstruction. Complications were less frequent after LA compared with OA (10.2 % vs 23.7 %, respectively)(P = 0.01). There were less wound infections in the LA group than in the OA group (8.5% vs 14.2%, respectively)(P=0.02), and all the complications were minor compared with that for the OA group. A postoperative intraabdominal abscess developed in one patient in the OA group, but this didn't occur in the LA group. There were no serious complications requiring readmission or reoperation in the LA group.
CONCLUSION
LA showed a significant benefit over OA in this study. The findings suggest that LA could be a safe primary choice for treating complicated appendicitis. To reach a final consensus on the scope of this study, a prospective randomized controlled study is needed in the near future.