Is postponed laparoscopic appendectomy justified for patients with acute appendicitis?

IntroductionRecent meta-analyses revealed that laparoscopic appendectomy (LA) is a feasible procedure even for patients with complicated appendicitis. More than a few patients with acute appendicitis arrive at the hospital during night shifts and have their operation postponed for various reasons. However, the feasibility and disadvantages of this so-called "postponed laparoscopic appendectomy" (PLA) remain controversial. MethodsWe included 149 patients who underwent LA for acute appendicitis within 48h of diagnosis between January 2013 and May 2018. Patients were divided into an immediate LA group (patients who underwent LA within 4h of diagnosis, n=84) and a PLA group (patients who underwent LA 4-48h after diagnosis, n=65). Comparisons were made between these groups. ResultsThe preoperative characteristics of the patients in the immediate LA and PLA groups were not significantly different. Operative time was significantly longer in the PLA group than in the LA group (92.540.8 vs 78.1 +/- 29.7min, P=0.012). The incidence of postoperative complications (grade II or higher) was significantly greater in the PLA group than in the LA group (32.3% vs 17.8%, P=0.041). Multivariate analysis revealed that a preoperative CT finding of periappendiceal fluid (P=0.005, odds ratio=4.71) and surgery 4-48h after diagnosis (P=0.005, odds ratio=4.425) were independent risk factors of postoperative complications (grade II or higher). ConclusionsFor patients with acute appendicitis, surgeons should perform immediate LA, if that is the patient's preferred surgical treatment, as long as there is no special reason to postpone surgery.