Open Appendectomy For Complicated Appendicitis Research Articles

Outcomes for open and laparoscopic appendicectomy for complicated appendicitis in children

The study aimed to compare the outcomes of paediatric laparoscopic appendectomy (LA) with open appendectomy (OA) for complicated appendicitis (CA). All trainees could perform OA without supervision.This is a single-centre, retrospective, non-randomised review of children 4-12 years of age, who had either an OA or LA for CA. The data was collected from August 2012 to June 2016. Nineteen surgical trainees were initially supervised by a consultant until deemed able to perform LA safely. The on-call surgeon decided on operative approach. Intra- and postoperative complications were analysed. Primary endpoint was comparison of infection rates between groups, simultaneous differences between the two procedures performed by surgical trainees and consultants were evaluated.One hundred and fifty-five patients had appendicectomy for CA during the study period. Fourteen patients with incomplete information were excluded. Ninety had OAs and 51 LAs. Both groups were well matched demographically. Postoperative infective complications occurred in 13/51 (25.5%) of the LAs, and in 23/90 (25.6%) of the OA (p = 0.159). Fourteen trainees performed 27 LAs without consultant supervision by the conclusion of the study. The mean duration of LA surgery for surgical trainees was 110.35 minutes (IQR 22.5) and for consultants 93.87 minutes (IQR 35, p = 0.497).There is no difference in intra- and postoperative complications between LA and OA for CA. Duration of surgery between surgical trainees and consultants were comparable. This indicates that surgical trainees acquire LA skill over a short period of time and that LA as a laparoscopic teaching procedure merits consideration.

Does abdominal drainage improve outcomes after open appendectomy for complicated appendicitis?

Does abdominal drainage improve outcomes after open appendectomy for complicated appendicitis?

Abdominal drainage to prevent intra-peritoneal abscess after appendectomy for complicated appendicitis.

This is the second update of a Cochrane Review first published in 2015 and last updated in 2018. Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer postoperative complications. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial. To assess the safety and efficacy of abdominal drainage to prevent intraperitoneal abscess after appendectomy (irrespective of open or laparoscopic) for complicated appendicitis; to compare the effects of different types of surgical drains; and to evaluate the optimal time for drain removal. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase, Web of Science, the World Health Organization International Trials Registry Platform, ClinicalTrials.gov, Chinese Biomedical Literature Database, and three trials registers on 24 February 2020, together with reference checking, citation searching, and contact with study authors to identify additional studies. We included all randomised controlled trials (RCTs) that compared abdominal drainage versus no drainage in people undergoing emergency open or laparoscopic appendectomy for complicated appendicitis. We also included RCTs that compared different types of drains and different schedules for drain removal in people undergoing appendectomy for complicated appendicitis. We used standard methodological procedures expected by Cochrane. Two review authors independently identified the trials for inclusion, collected the data, and assessed the risk of bias. We used the GRADE approach to assess evidence certainty. We included intraperitoneal abscess as the primary outcome. Secondary outcomes were wound infection, morbidity, mortality, hospital stay, hospital costs, pain, and quality of life. Use of drain versus no drain We included six RCTs (521 participants) comparing abdominal drainage and no drainage in participants undergoing emergency open appendectomy for complicated appendicitis. The studies were conducted in North America, Asia, and Africa. The majority of participants had perforated appendicitis with local or general peritonitis. All participants received antibiotic regimens after open appendectomy. None of the trials was assessed as at low risk of bias. The evidence is very uncertain regarding the effects of abdominal drainage versus no drainage on intraperitoneal abscess at 30 days (risk ratio (RR) 1.23, 95% confidence interval (CI) 0.47 to 3.21; 5 RCTs; 453 participants; very low-certainty evidence) or wound infection at 30 days (RR 2.01, 95% CI 0.88 to 4.56; 5 RCTs; 478 participants; very low-certainty evidence). There were seven deaths in the drainage group (N = 183) compared to one in the no-drainage group (N = 180), equating to an increase in the risk of 30-day mortality from 0.6% to 2.7% (Peto odds ratio 4.88, 95% CI 1.18 to 20.09; 4 RCTs; 363 participants; low-certainty evidence). Abdominal drainage may increase 30-day overall complication rate (morbidity; RR 6.67, 95% CI 2.13 to 20.87; 1 RCT; 90 participants; low-certainty evidence) and hospital stay by 2.17 days (95% CI 1.76 to 2.58; 3 RCTs; 298 participants; low-certainty evidence) compared to no drainage. The outcomes hospital costs, pain, and quality of life were not reported in any of the included studies. There were no RCTs comparing the use of drain versus no drain in participants undergoing emergency laparoscopic appendectomy for complicated appendicitis. Open drain versus closed drain There were no RCTs comparing open drain versus closed drain for complicated appendicitis. Early versus late drain removal There were no RCTs comparing early versus late drain removal for complicated appendicitis. The certainty of the currently available evidence is low to very low. The effect of abdominal drainage on the prevention of intraperitoneal abscess or wound infection after open appendectomy is uncertain for patients with complicated appendicitis. The increased rates for overall complication rate and hospital stay for the drainage group compared to the no-drainage group are based on low-certainty evidence. Consequently, there is no evidence for any clinical improvement with the use of abdominal drainage in patients undergoing open appendectomy for complicated appendicitis. The increased risk of mortality with drainage comes from eight deaths observed in just under 400 recruited participants. Larger studies are needed to more reliably determine the effects of drainage on morbidity and mortality outcomes.

Assessment of the Outcomes of Laparoscopic Versus Open Appendectomy: A Cross-sectional Study

Introduction: We conducted a cross-sectional study in two institutions for reviewing the postoperative complications of laparoscopic appendectomy vs open appendectomy for complicated appendicitis. The primary objectives were detection of surgical site infection and reoperation within 30 days postoperatively. The secondary objectives were reducing the length of hospital stay, increasing patient satisfaction level, and identifying other diseases and postoperative complications like pneumonia, deep vein thrombosis, bedsores, and enterocutaneous fistulas. Materials and Methods: We analyzed 683 patients that met the inclusion criteria and their clin- ical data and hospital costs. The patients were divided into two groups: open appendectomy (OA) group and laparo- scopic appendectomy (LA) group. The collected clinical data included demographic data, co-morbidities, initial laboratory findings, operation time, intraoperative findings (acute, gangrenous or perforated appendix), time to soft diet, postoperative hospital stay, amount of analgesics and postoperative complications. Results: The laparoscopic group required fewer doses of paren- teral and oral analgesics in the operative and post- operative periods compared with the open appendectomy (P <0.0001). Bowel movements in the first postoperative day were observed in 93.5% patients subjected to laparoscopic appendectomy and 68.1% in the open group (P <0.001). As a result, 86.8% patients in the laparoscopic group and 61.1% in the open group were able to toler- ate a liquid diet within the first 24 postoperative hours (P <0.001). Conclusion: Our results showed the advantages of the laparoscopic approach over open appendectomy including shorter hospital stay, decreased need for postoperative analgesia, early food tolerance, earlier return to work, lower rate of wound infection, against only marginally higher hospital costs. Furthermore we found a considerable preference (during the collection of consent) of patients and a high satisfaction after the surgery in the laparoscopic group.

Comparison of Superficial Surgical Site Infection between Delayed Primary versus Primary Wound Closure in Complicated Appendicitis

Abstract Background: Acute appendicitis is the most common cause of acute abdomen in adults. Open appendicectomy is the treatment of choice for complicated appendicitis. Perforated appendicitis has an infection rate 15-20% post-operative surgical site infection can increase morbidity. Thus it can lead to increase in post-operative pain, hospital stay, sepsis and patient dissatisfaction, Surgical Site Infection (SSI) and its associated complications like wound dehiscence, stitch sinuses, incisional hernias, hypertrophic scar and keloid formation are not only a source of discomfort for the patients but also discouraging for the surgeons. These complications prolong the post-operative stay of patient and increase the cost of treatment. Aim of Study: To compare the efficacy of primary wound closure with delayed primary wound closure in terms of wound infection after surgery for perforated appendix and get local evidence of the effectiveness of either procedure. Patients and Methods: This study was done between May 2018 and December 2018 in the General Surgery Department in Ain Shams University Hospital and Damietta General Hospital. The study included 50 patients presented with complicated appendicitis. The patients were divided into 2 groups A and B using lottery method. Patient in group-A underwent primary closure of the skin immediately after surgery while patients in group-B were subjected to delayed primary closure of the skin for perforated appendix. Results: In our study, in delayed primary closure there was 2 patients with positive signs of superficial surgical wound infection but in primary closure there was 11 patients. The total post-operative hospital stay in delayed primary closure ranges from 4 to 9 days and in primary closure ranges from 3 to 9 days with no significant difference between the two groups. Conclusion: Our study suggested that patients undergoing open appendectomy for complicated appendicitis, DPC was the preferable method for wound management than primary closure because of a lower incidence of wound infection DPC could be considered for wound management in patients with perforated appendicitis.

Does abdominal drainage improve outcomes after open appendectomy for complicated appendicitis?

Does abdominal drainage improve outcomes after open appendectomy for complicated appendicitis?

Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis.

Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer from postoperative complications. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial.This is an update of the review first published in 2015. To assess the safety and efficacy of abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 6), Ovid MEDLINE (1946 to 30 June 2017), Ovid Embase (1974 to 30 June 2017), Science Citation Index Expanded (1900 to 30 June 2017), World Health Organization International Clinical Trials Registry Platform (30 June 2017), ClinicalTrials.gov (30 June 2017) and Chinese Biomedical Literature Database (CBM) (1978 to 30 June 2017). We included all randomised controlled trials (RCTs) that compared abdominal drainage and no drainage in people undergoing emergency open appendectomy for complicated appendicitis. Two review authors identified the trials for inclusion, collected the data, and assessed the risk of bias independently. We performed the meta-analyses using Review Manager 5. We calculated the risk ratio (RR) for dichotomous outcomes (or a Peto odds ratio for very rare outcomes), and the mean difference (MD) for continuous outcomes with 95% confidence intervals (CI). We used GRADE to rate the quality of evidence. We included six RCTs (521 participants), comparing abdominal drainage and no drainage in patients undergoing emergency open appendectomy for complicated appendicitis. The studies were conducted in North America, Asia and Africa. The majority of the participants had perforated appendicitis with local or general peritonitis. All participants received antibiotic regimens after open appendectomy. None of the trials was at low risk of bias.There was insufficient evidence to determine the effects of abdominal drainage and no drainage on intra-peritoneal abscess at 14 days (RR 1.23, 95% CI 0.47 to 3.21; 5 RCTs; 453 participants; very low-quality evidence) or for wound infection at 14 days (RR 2.01, 95% CI 0.88 to 4.56; 5 RCTs; 478 participants; very low-quality evidence). The increased risk of 30-day overall complication rate (morbidity) in the drainage group was rated as very low-quality evidence (RR 6.67, 95% CI 2.13 to 20.87; 1 RCT; 90 participants). There were seven deaths in the drainage group (N = 183) compared to one in the no drainage group (N = 180), equating to an increase in the risk of 30-day mortality from 0.6% to 2.7% (Peto odds ratio (OR) 4.88, 95% CI 1.18 to 20.09; 4 RCTs; 363 participants; moderate-quality evidence). There is 'very low-quality' evidence that drainage increases hospital stay compared to the no drainage group by 2.17 days (95% CI 1.76 to 2.58; 3 RCTs; 298 participants).Other outlined outcomes, hospital costs, pain, and quality of life, were not reported in any of the included studies. The quality of the current evidence is very low. The effect of abdominal drainage on the prevention of intra-peritoneal abscess or wound infection after open appendectomy is uncertain for patients with complicated appendicitis. The increased rates for overall complication rate and hospital stay for the drainage group compared to no drainage group is also subject to great uncertainty. Thus, there is no evidence for any clinical improvement by using abdominal drainage in patients undergoing open appendectomy for complicated appendicitis. The increased risk of mortality with drainage comes from eight deaths observed in just under 400 people recruited to the studies. Larger studies are needed to determine the effects of drainage on morbidity and mortality outcomes more reliably.

Does abdominal drainage improve outcomes after open appendectomy for complicated appendicitis?

Does abdominal drainage improve outcomes after open appendectomy for complicated appendicitis?

Comparison of clinical outcome of laparoscopic versus open appendectomy for complicated appendicitis.

Laparoscopic appendectomy is now the treatment of choice in uncomplicated appendicitis. To date its importance in the treatment of complicated appendicitis is not clearly defined. From January 2005 to June 2013 a total of 1762 patients underwent appendectomy for the suspected diagnosis of appendicitis at our institution. Of these patients 1516 suffered from complicated appendicitis and were enrolled. In total 926 (61%) underwent open appendectomy (OA) and 590 (39%) underwent laparoscopic appendectomy (LA). The following parameters were retrospectively analyzed: age, sex, operative times, histology, length of hospital stay, 30-day morbidity focusing on occurrence of surgical site infections, intraabdominal abscess formation, postoperative ileus and appendiceal stump insufficiency, conversion rate, use of endoloops and endostapler. A statistically significant difference in operative time was observed between the laparoscopic and the open group (64.5 vs. 60min; p=0.002). Median length of hospitalization was significantly shorter in the laparoscopic group (p<0.000). Surgical site infections occurred exclusively after OA (38 vs. 0 patients). Intraabdominal abscess formation occurred statistically significantly more often after LA (2 vs. 10 patients; p=0.002). There were no statistical significances concerning the occurrence of postoperative ileus (p=0.261) or appendiceal stump insufficiencies (p=0.076). The laparoscopic approach for complicated appendicitis is a safe and feasible procedure. Surgeons should be aware of a potentially higher incidence of intraabdominal abscess formation following LA. Use of endobags , inversion of the appendiceal stump and carefully conducted local irrigation of the abdomen in a supine position may reduce the incidence of abscess formation.

Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis.

Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer from postoperative complications. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial. To assess the safety and efficacy of abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. We searched The Cochrane Library (Issue 1, 2014), MEDLINE (1950 to February 2014), EMBASE (1974 to February 2014), Science Citation Index Expanded (1900 to February 2014), and Chinese Biomedical Literature Database (CBM) (1978 to February 2014). We included all randomised controlled trials (RCTs) that compared abdominal drainage and no drainage in patients undergoing emergency open appendectomy for complicated appendicitis. Two review authors identified the trials for inclusion, collected the data, and assessed the risk of bias independently. We performed the meta-analyses using Review Manager 5. We calculated the risk ratio (RR) for dichotomous outcomes (or a Peto odds ratio for very rare outcomes), and the mean difference (MD) for continuous outcomes with 95% confidence intervals (CI). We included five trials involving 453 patients with complicated appendicitis who were randomised to the drainage group (n = 228) and the no drainage group (n = 225) after emergency open appendectomies. All of the trials were at a high risk of bias. There were no significant differences between the two groups in the rates of intra-peritoneal abscess or wound infection. The hospital stay was longer in the drainage group than in the no drainage group (MD 2.04 days; 95% CI 1.46 to 2.62) (34.4% increase of an 'average' hospital stay). The quality of the current evidence is very low. It is not clear whether routine abdominal drainage has any effect on the prevention of intra-peritoneal abscess after open appendectomy for complicated appendicitis. Abdominal drainage after an emergency open appendectomy may be associated with delayed hospital discharge for patients with complicated appendicitis.

Laparoscopic versus open appendectomy for complicated appendicitis in high risk patients.

Laparoscopic appendectomy is widely used for the treatment of complicated appendicitis. Its use in patients with high operative risk is still on debate. The aim of the presented study was to investigate the benefits of laparoscopic appendectomy in patients with high peri- and postoperative risk factors. We performed a retrospective analysis of all patients who underwent appendectomy in our center between 2006 and 2013. Patients were classified according to their preoperative risk (classification of the American Society of Anesthesia--ASA score). Only patients with ASA 3 and 4 were included and were divided into two groups--open appendectomy (OA group) and laparoscopic appendectomy (LA group). The operation time was slightly longer in the LA group (p = 0.05), but hospital stay was shorter (p = 0.05). Complications graded according to the Clavien Dindo classification were slightly more frequent in patients after LA, whereas severe complications occurred more frequently in patients after OA (p = 0.01). The postoperative WBC decreased steadily and significantly in patients after OA, whereas the decrease in patients after LA was delayed (p = 0.03). CRP slightly increased after OA and decreased thereafter, whereas it steadily decreased after LA (p = 0.05). Laparoscopic appendectomy can be recommended for patients with complicated appendicitis even with higher risk categories.

Invited commentary on "Werkgartner G. et al.: Laparoscopic versus open appendectomy for complicated appendicitis in high risk patients".

The authors discuss a very important and controversial topic: Is laparoscopic appendectomy for complicated appendicitis in high-risk patients with an ASA score of 3 or 4 associated with a justifiable risk? Compared to open appendectomy, is the risk comparable or even less? On the one hand, the risk of postoperative complications in multimorbid patients is increased. On the other hand, the question is, whether or not the laparoscopic technique further and unnecessarily increases that risk. To answer these questions, the authors retrospectively analyzed the appendectomies from their institution over a course of 8 years and extracted those patients with both complicated appendicitis and ASA score of 3 or 4. These were then analyzed after having been divided into two groups, namely open and laparoscopic procedures. A conversion rate is not available. Evaluated preoperative parameters were age, gender, and comorbidities, Leucocyte count, CRP, ASA score, and fever. Documented intraand postoperative parameters were perforation, procedural time, hospital stay, complications rated according to Clavien/Dindo, as well as Leucocyte-count and CRP on the first and third postoperative day. The flaw in this analysis can be seen in the missing comparability of the two groups. The choice of operative technique was left to the surgeons and was definitely influenced by the comorbidities. As the authors state, conventional appendectomy is the preferred method in their institution in case of severe cardiac or pulmonary comorbidities. Thus, it does not come as a surprise that these are overrepresented in the OA group. Almost half of the OA patients (45 %) were rated as NYHA IV. According to the authors, this was a contraindication for laparoscopy. Therefore, half of the patients in the OA group would not have been operated upon laparoscopically, which forbids comparison of the two groups. Similar differences between the two groups appear for age and the fraction of the ASA 4 patients. Furthermore, a markedly higher amount of perforations appeared in the OA group. As a conclusion, the significant differences are certainly not based on a statistically randomized pattern, but possibly entirely on differences in both populations. In order to allow a separate influence of the operative technique on the complication rate, a multivariate analysis is needed. However, for this statistical tool, the case number is too low. A multicenter trial is probably the most suitable method to extensively answer the proposed questions. As the authors correctly remark, a prospective, randomized trial would be hard to realize for this topic. Also, especially in a retrospective analysis, utilization of the ASA classification seems questionable, since the ASA classification is too simplistic and highly subjective. However, the authors’ analysis impressively shows that for complicated appendicitis, the laparoscopic technique could be performed in ASA 3/4 patients, excluding those with a NYHA IV score, after subjective selection by the performing surgeon with an acceptable rate of complication in their institution. However, I find that the direct comparison with the open technique is limited for the reasons mentioned above. A further interesting result of the study is that the rise in CRP value in case of a postoperative complication is not as high following a laparoscopic appendectomy as compared to an open procedure. Thus, a complication might take a more concealed course. This deserves further evaluation in future trials.

Comparison of Clinical Outcomes after Laparoscopic and Open Appendectomy for Complicated Appendicitis

Purpose: Acute appendicitis is one of the most common surgical emergencies worldwide. Laparoscopic appendectomy (LA) is being accepted as the ‘gold standard’ surgery for simple acute appendicitis over open appendectomy (OA); however, for complicated appendicitis, no consensus has been reached with regard to which produces better outcomes. Methods: We analyzed the data of patients who were diagnosed as complicated appendicitis, older than 18 years old, and underwent LA or OA from January 2008 to December 2012. A total of 2,173 patients had acute appendicitis during this period and 461 (21.2%) of them had complicated appendicitis; 335 patients were finally enrolled and divided into LA (280), OA (49), and Converted to open Appendectomy (CA) groups (6), respectively. Age, sex, preoperative WBC, operating time, stapler usage, time to diet and discharge, total cost and complication among the three groups were analyzed. Results: No significant differences were observed in sex, age, history of abdominal surgery, preoperative WBC, and total cost. Shorter operating time (62.3±30.0 vs 87.3±40.2, p=0.000), shorter time to diet (2.7±2.2 vs 3.7±1.6, p=0.001), shorter postoperative stay (4.8±2.6 vs 7.1±2.5, p=0.000), shorter duration of pain (3.4±1.7 vs 5.6±2.8, p=0.000), and less frequent usage of pain killer (68.2% vs 89.1%, p ＜0.001) were observed in the laparoscopic group. Complication rate was significantly lower in the LA group (4.6% vs 18.4%, p=0.002). Conclusion: Results of this study provide clinical evidence that laparoscopic surgery is a feasible and safe surgical modality for complicated appendicitis. Conduct of more reliable, large scaled, randomized prospective study will be necessary in order to prove the superiority of laparoscopic surgery for complicated appendicitis.

Pathologic Continuum of Acute Appendicitis

Appendicitis is one of the most common causes of the acute abdomen often requiring emergent surgery. Delayed diagnosis leads to the progression of uncomplicated appendicitis to complicated (gangrenous, perforated) appendicitis, often changing clinical management. Computed tomography and ultrasound are imaging modalities of choice to preoperatively diagnose appendicitis. Recent concerns of radiation exposure and cost have renewed interest in using ultrasound as an initial, diagnostic study. A sonographic pictorial and histopathologic review of the continuum of appendicitis is presented. A comprehensive sonographic examination of the appendix should investigate the size (maximal diameter), the echogenic submucosal layer integrity, the mural color Doppler signature, the presence of a fecalith, and the periappendiceal changes. Features of an uncomplicated appendicitis include size greater than 6 to 7 mm, hyperemia on color Doppler, mural thickening, and an intact echogenic submucosal layer. Gangrenous appendicitis is characterized by loss of the echogenic submucosal layer with absent color Doppler flow. Loculated pericecal fluid, prominent pericecal fat, and circumferential loss of the submucosal layer are suggestive of perforation. Sonographic staging can triage management of appendicitis by directing urgent laparoscopic appendectomy for uncomplicated appendicitis, open appendectomy for complicated appendicitis, and conservative management (antibiotics with percutaneous drainage) for perforated appendicitis with abscess formation.

A Clinical Comparison of Laparoscopic versus Open Appendectomy for Complicated Appendicitis

PurposeAlthough laparoscopic appendectomies (LAs) are performed universally, a controversy still exists whether the LA is an appropriate surgical approach to complicated appendicitis (CA). We retrospectively evaluated the outcomes of laparoscopic versus open appendectomies for CA.MethodsWe retrospectively analyzed 60 consecutive patients who were diagnosed as having CA from July 2009 to January 2011. Outcomes such as operative time, time to soft diet, length of hospital stay, and postoperative complications were analyzed.ResultsThere were no statistically significant differences in operative time between the LA and the open appendectomy (OA) groups. Return to soft diet was faster in the LA group (2.1 ± 1.2 vs. 3.5 ± 1.5 days; P = 0.001). Length of hospital stay was shorter for the LA group (4.4 ± 2.3 vs. 5.8 ± 2.9 days; P = 0.045). The overall complication rates showed no statistically significant difference between the two groups. In cases involving a periappendiceal abscess, the LA had a significantly higher incidence of intra-abdominal abscess (IAA) and postoperative ileus (PI; P = 0.028).ConclusionThe LA showed good results in terms of the time to soft diet, the length of hospital stay, and surgical site infection (SSI) whereas the overall complication rates were similar for the two groups. However, the LA was associated with significantly higher incidence of IAA and PI for the cases with a periappendiceal abscess. Therefore, when using a LA, the surgeon must take great care to minimize the incidence of IAA and PI if a periappendiceal abscess is present.

Laparoscopic Versus Open Appendectomy in Complicated Appendicitis. A Review of the NSQIP Database

Introduction: Laparoscopic appendectomy (LA) has been an established treatment method for uncomplicated acute appendicitis for twenty years. Controversy still exists regarding the superiority of either technique for the treatment of complicated appendicitis. Objective: To examine and elucidate any benefits in post operative morbidity and mortality when comparing laparoscopic versus open appendectomy for complicated appendicitis. Method and Design of Study: A retrospective analysis was performed using the American College of Surgeon's National Surgical Quality Improvement Project (ACS-NSQIP) dataset between 2005 and 2007.

Complicated Appendicitis–Is the Laparoscopic Approach Appropriate? A Comparative Study with the Open Approach: Outcome in a Community Hospital Setting

Good outcome has been reported with the laparoscopic approach in uncomplicated appendicitis, but a higher incidence of postoperative intraabdominal abscesses has been reported after laparoscopic appendectomy in complicated appendicitis. This retrospective comparative study compares outcome after laparoscopic (LA) and open appendectomy (OA) in complicated appendicitis. All patients who had LA or OA for complicated appendicitis between January 2003 and February 2006 were included in the study. Data collection included demographics, operative time, estimated blood loss, length of stay (LOS), complications, readmission, and reoperative rates. The primary end points for analysis were postoperative intraabdominal abscess and complication rates and secondary end points were LOS and operative time. All data were analyzed on an intent-to-treat basis. Of 104 patients, 43 patients underwent LA and 61 had OA. The mean age (24.8 +/- 16.5 versus 31.3 +/- 18.9, P = 0.08) in the LA group was lower than the OA group because there was a significantly higher proportion of pediatric patients (34.8% versus 14.8%, P = 0.02) who had LA. There was no significant difference in gender (female/male, 14/29 versus 27/34, P = 0.3) or American Society of Anesthesiologists class distribution (American Society of Anesthesiologists 1/2/3/4/, 35/7/1/0 versus 45/12/3/1, P = 0.68) between the two groups. The operative time (100.5 +/- 36.2 versus 81.5 +/- 29.5 minutes, P = 0.03) was significantly longer and the estimated blood loss (21 mL versus 33 mL, P = 0.01) was lower in LA when compared with OA, but there was no significant difference in the number of patients with preoperative peritonitis versus abscesses (7/36 versus 13/48, P = 0.6) in both groups. There was no difference in the median LOS (6 [interquartile range 5-9] versus 6 [interquartile range 4-8], P = 0.7) in the two groups. The conversion rate in LA was 18.6% (n = 8). There was also no significant difference in the complication (17/43 [39.5%] versus 21/61 [34.4%], P = 0.54), reoperative (3/43 [7%] versus 0/61 [0%], P = 0.07), and 30-day readmission (5/41 [11.6%] versus 3/61 [4.9%], P = 0.23) rates between the two groups. The rate of postoperative intraabdominal abscesses was significantly higher in the LA group when compared with the OA group (6/43 [14%] versus 0/61 [0%], P = 0.04) and the wound infection (1/43 [2.3%] versus 5/61 [8.2%], P = 0.4) and pulmonary complication (0/43 [0%] versus 3/61 [4.9%], P = 0.26) rate was higher in the OA group. There was no mortality in the LA group, but there was one mortality in the OA group resulting from postoperative myocardial infarction. Laparoscopic appendectomy can be performed in patients with complicated appendicitis with a comparative operative time, LOS, and complication rates but results in a significantly higher intraabdominal abscess rate and lower wound infection rate when compared with OA.