New strategy during complicated open appendectomy: Convert open operation to laparoscopy

AIM: To introduce a new strategy during complicated open appendectomy- converting open operation to laparoscopy.METHODS: We retrospectively reviewed databases at two institutions between October 2010 and January 2013, identifying 826 patients who had undergone complicated appendectomy for histologically confirmed acute or chronic appendicitis. They included 214 complicated appendectomies: 155 lengthened-incision open appendectomies(LIA group) and 59 open appendectomies with conversion to laparoscopy(OACL group).RESULTS: A total of 214 patients with complicated appendectomies were included in the study, including 155 cases of LIA and 59 cases of OACL. No major complication leading to death occurred in the study. Patient characteristics of the two groups were similar. Several parameters showed a significant difference betweenthe two groups. For the OACL vs LIA groups they were, respectively: incision length(3.8 ± 1.4 cm vs 6.2 ± 3.5 cm, P < 0.05); time to flatus recovery(2.3 ± 0.6 d vs 4.2 ± 0.8 d, P < 0.05), drainage rate(61.0% vs 80.0%, P < 0.05); pain level(3.6 ± 1.8 vs 7.2 ± 2.4, P < 0.05); hospital stay(5.1 ± 2.7 d vs 8.7 ± 3.2 d, P < 0.05); complication rate(8.5% vs 14.7%, P < 0.05). Other factors showed no significant differences.CONCLUSION: Lengthened-incision open appendectomy increases the incidence of complications and prolongs the hospital stay. Conversion of open to laparoscopic appendectomy is feasible and efficient in complicated cases. It decreases the rate of incisional and abdominal infections, allows faster return of bowel movements, and shortens the hospital stay.