Efficacy of laparoscopy in complicated appendicitis

Background: Laparoscopic appendectomy has been widely practiced for uncomplicated appendicitis. The role of laparoscopy in management of complicated appendicitis remains undefined. We undertook this study to evaluate the efficacy of laparoscopic appendectomy in patients with complicated appendicitis. Method: This study involved a total of 110 consecutive patients who had undergone appendectomy for perforated or gangrenous appendicitis between March 2004 and December 2008. Sixty-one patients underwent open appendectomy (OA) and remaining 49 patients underwent laparoscopic appendectomy (LA). Parameters studied were operative time, conversion rate, wound infections, intra-abdominal abscess and duration of pain and hospital stay. Results: There were two conversions due to extremely friable appendix. Laparoscopic appendectomy took longer to perform (98 min versus 79 min) but was associated with less analgesic use, shorter median hospital stay (LA- 3 days; OA- 6 days, p < 0.05), and lower rate of wound infections (LA, 8.2%; OA, 24.6 %, p < 0.05). Intra-abdominal abscess occurred in four patients (8.2%) in LA group and fourteen patients (22.9%) in OA group (p < 0.05). More patients in OA group experienced prolonged ileus than LA group but the difference was statistically insignificant. All complications were managed conservatively and there was no mortality in either group. Conclusions: Laparoscopic appendectomy for complicated appendicitis is feasible and safe. It is associated with less postoperative pain, lower incidence of infectious complications and reduced length of hospital stay when compared with patients who had open appendectomy. (c) 2009 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.