Risk Factors Affecting Postoperative Morbidity in Laparoscopic Treatment of Perforated Appendicitis, a Single- Center Experience

Objective: Postoperative morbidity may occur more in laparoscopic treatment of perforated appendicitis than simple appendicitis. In this study, we aimed to investigate the risk factors affecting the development of morbidity in laparoscopic treatment of perforated appendicitis. Method: The files of patients who underwent laparoscopic appendectomy due to perforated appendicitis were analysed retrospectively. Finding of perforation has been documented by surgeons who performed surgery. Information on the patients such as age, gender, Charlson Comorbidity Index (CCI), body mass index (BMI), ASA scores, symptom onset time, time between hospital admission and surgery, surgical findings, perforation sites, type of surgery, stump closure materials, white blood cell counts, pathology results and postoperative morbidities were recorded. Data were compared between patients with and without morbidity, and multivariate regression analysis of variables with significant p value was performed. Results: The rate of morbidity development in laparoscopic treatment of perforated appendicitis was 22.14% (66/298). In multivariate regression analysis, the onset of symptoms longer than 72 hours, proximal perforation, grade 5 diffuse peritonitis in surgical finding according to Disease Severity Score (DSS), conversion from laparoscopic to open surgery and gangrene or necrosis in histopathological finding were found to be effective risk factors in the development of morbidity. (p=0.013, odds ratio=1,455, p=0.010, odds ratio=2.009, p=0.002, odds ratio=2.648, p=0.014, odds ratio=6.537, p=0.003, odds ratio=1.843; respectively). Conclusion: The development of postoperative morbidity in laparoscopic treatment of perforated appendicitis is associated with late admission development of diffuse peritonitis, conversion to open surgery, proximal perforation and presence of necrosis. According to odds ratio, the risk factor with the highest probability of developing morbidity was found to be conversion to open surgery. We think that patients diagnosed with perforated appendicitis should be operated on as early as possible, routinely placing a drain should be avoided, and laparoscopic approach should be preferred as much as possible to reduce the morbidity rates.