Laparoscopy in Simple and Complicated Appendicitis: How Does It Differ

Abstract

Introduction: laparoscopic appendectomy (LA) has been established as a surgical technique in the management of acute appendicitis in several studies. Although LA is considered safe and effective in acute non-complicated cases, the technique is not gaining the same widespread acceptance in the complicated cases. The considerable high rate of conversion into open surgery and safety of the procedure in complicated cases makes the outcome somewhat different from that of the non-complicated cases. This study was designed to compare the outcome of the LA in both simple and complicated acute appendicitis. Methods: The study included ninety patients who were above 18 years of age with either acute simple or acute complicated appendicitis. There are divided into two groups (G1 & G2). G1 included complicated cases while G2 included simple cases. LA was performed to all patients. The outcome of the procedure in terms of rate of conversion to open surgery, operation time, hospital stay, time of return to work and the complications rate was compared between both groups. Results: Gl included 40 patients (44%) while G2 included 50 patients (56%). The operative time was significantly longer in Gl than G2 (115 ± 18.6 vs 65 ± 10.4) (P=0.02). Conversion to open surgery occurred in 11 patients (27.5%) of G1 and in 4 patients (8%) of G2 (P=0.01). The main causes of conversion were difficult skeletonization of the appendix and inability to control bleeding from non-visualized source. The overall length of hospital stay was significantly higher in G1 patients (P=0.02) while the time needed to return to work was statistically insignificant between both groups (P=0.12). The incidence of complications was greater in G1 (8/40) as compared to G2 (2/50) (P=0.001). There were no mortalities and no patients required re-operation in either group. Conclusion: LA is feasible and advantageous in both simple and complicated appendicitis. However; great caution and high level of experience are need in complicated cases because of its relatively high rates of complication and conversion to open procedure.