Comparatively study of laparoscopic and open surgery for postoperative complications of acute gangrenous appendicitis

Abstract

Objective To analyze and compare the incidence of postoperative complications of acute gangrene appendicitis after laparotomy and laparoscopic surgery. Methods This study retrospectively analyzed of 162 cases of acute gangrenous appendicitis treated in Xilin Guole Meng Hospital from January 2015 to January 2018. There were 96 male patients and 66 female patients; age (43.40±16.21) years. According to different surgical methods, 162 patients were divided into two groups: laparoscopic group (n=80) and open group (n=82). Laparoscopic appendectomy was performed in the laparoscopic group, and open appendectomy was performed in the open group. To compare the postoperative complications intraoperative and postoperative data between the two groups. It consists of tump fistula or bead inflammation, postoperative pneumonia, abdominal hemorrhage, deep venous thrombosis, incisional hernia, subcutaneous emphysema, incision infection, intestinal obstruction, celiac sepsis, complained of pain intensity classification method for pain score and antibiotic use time, postoperative extubation time, postoperative exhaust time, postoperative bed for the first time for the first time time, length of hospital stay. The measurement data were expressed by (Mean±SD) and the t test was used with the groups. The counting data were expressed by the percentage or rate and the χ2 test was used among the groups. When the number of single group cases was less than 10 cases, the Fisher exact probability method was used for the calibration test. Results The top three complications were incision infection, intestinal obstruction and empyema. The incidence of postoperative complications in open group and laparoscopy group was 65.9% (54/82) and 8.8% (7/80) respectively, and there was significant difference between the two groups (F=56.247, P=0.000). The VRS of the laparoscopic group and the open group were 53 points and 12 points for grade I, 18 points and 36 points for grade Ⅱ, and 9 points and 34 points for grade Ⅲ, The results showed that the difference between the two groups was statistically significant (χ2=2.45, P=0.01). The time of antibiotic use, postoperative tube extraction, postoperative first exhaust, postoperative first time out of bed and hospitalization in the laparoscopic group were respectively (61.2±24.2) d, (4.2±1.2) h, (24.6±6.9) h, (4.6±2.2) h, ( 5.5±3.6) d and the open group were (72±72.6) d, (7.4±2.7) h, (52.2±4.8) h, (8.4±2.6) h, (13.5±8.2) d respectively, the differences were statistically significant (P<0.05). Conclusion The postoperative complications in laparoscopic group were lower than those in open group, so the laparoscopic group was the first choice for the treatment of acute appendicitis, while the open group was another choice for some patients. Key words: Appendicitis; Gangrene; Postoperative complications; Laparotomy; Laparoscopy