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Surgical Endoscopy

, Volume 34, Issue 2, pp 907–914 | Cite as

Laparoscopic versus open appendectomy for perforated appendicitis in adults: randomized clinical trial

  • Ahmed TalhaEmail author
  • Hany El-Haddad
  • Abd-Elhamid Ghazal
  • Gihan Shehata
Article
  • 222 Downloads

Abstract

Background

The advantages of laparoscopic appendectomy did not meet the same acceptance in the setting of perforated appendicitis as in uncomplicated appendicitis in the general surgical community. The aim of this study was to compare the clinical outcome of laparoscopic and open appendectomy in perforating appendicitis.

Methods

A randomized controlled study was conducted on 126 patients presenting with perforated appendicitis. Sixty patients were subjected to laparoscopic appendectomy (LA) and 66 patients underwent traditional open appendectomy (OA).

Results

65 (51.6%) patients were female, and 61 (48.4%) patients were male in whom the mean age was 37.6 + 8.5 years. A significant difference was calculated in the domains of postoperative pain, less need for analgesics, hospital stay, and return to daily activities. The mean operative time was shorter in OA 94 ± 10.4 min than LA 120.6 ± 17.7 min. No statistically significant difference between both groups was detected as regard occurrence of intra-abdominal collection.

Conclusion

In view of its clinical outcomes, laparoscopy should be considered in the context of perforated appendicitis. The possibility of intra-abdominal collection should not be a barrier against the widespread practice of this surgical procedure amidst laparoscopic surgeons if adequate precautions are employed.

Keywords

Perforated appendicitis Peritonitis Laparoscopy Complicated appendicitis 

Notes

Compliance with ethical standards

Disclosures

Ahmed Talha, Hany El-Haddad, Abd-Elhamid Ghazal and Gihan Shehata have no conflict of interest or financial ties to disclose.

References

  1. 1.
    Teixeira PG, Demetriades D (2013) Appendicitis: changing perspectives. Adv Surg 47:119–140PubMedCrossRefGoogle Scholar
  2. 2.
    Petroianu AVBT (2016) Pathophysiology of acute appendicitis. JSM Gastroenterol Hepatol 4(3):1062–1066Google Scholar
  3. 3.
    Hale DA, Molloy M, Pearl RH, Schutt DC, Jaques DP (1997) Appendectomy: a contemporary appraisal. Ann Surg 225(3):252–261PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Khiria LS, Ardhnari R, Mohan N, Kumar P, Nambiar R (2011) Laparoscopic appendicectomy for complicated appendicitis: is it safe and justified?: a retrospective analysis. Surg Laparosc Endosc Percutan Tech 21(3):142–145PubMedCrossRefGoogle Scholar
  5. 5.
    Katkhouda N, Mason RJ, Towfigh S, Gevorgyan A, Essani R (2005) Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg 242(3):439–448PubMedPubMedCentralGoogle Scholar
  6. 6.
    Milewczyk M, Michalik M, Ciesielski M (2003) A prospective, randomized, unicenter study comparing laparoscopic and open treatments of acute appendicitis. Surg Endosc 17(7):1023–1028PubMedCrossRefGoogle Scholar
  7. 7.
    Kehagias I, Karamanakos SN, Panagiotopoulos S, Panagopoulos K, Kalfarentzos F (2008) Laparoscopic versus open appendectomy: which way to go? World J Gastroenterol 14(31):4909–4914PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Asarias JR, Schlussel AT, Cafasso DE, Carlson TL, Kasprenski MC, Washington EN et al (2011) Incidence of postoperative intraabdominal abscesses in open versus laparoscopic appendectomies. Surg Endosc 25(8):2678–2683PubMedCrossRefGoogle Scholar
  9. 9.
    Yeom S, Kim MS, Park S, Son T, Jung YY, Lee SA et al (2014) Comparison of the outcomes of laparoscopic and open approaches in the treatment of periappendiceal abscess diagnosed by radiologic investigation. J Laparoendosc Adv Surg Tech A 24(11):762–769PubMedCrossRefGoogle Scholar
  10. 10.
    Taguchi Y, Komatsu S, Sakamoto E, Norimizu S, Shingu Y, Hasegawa H (2016) Laparoscopic versus open surgery for complicated appendicitis in adults: a randomized controlled trial. Surg Endosc 30(5):1705–1712PubMedCrossRefGoogle Scholar
  11. 11.
    Yu MC, Feng YJ, Wang W, Fan W, Cheng HT, Xu J (2017) Is laparoscopic appendectomy feasible for complicated appendicitis? a systematic review and meta-analysis. Int J Surg 40:187–197PubMedCrossRefGoogle Scholar
  12. 12.
    Gomes CA, Sartelli M, Di Saverio S, Ansaloni L, Catena F, Coccolini F et al (2015) Acute appendicitis: proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings. World J Emerg Surg 10:60PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Lin HF, Wu JM, Tseng LM, Chen KH, Huang SH, Lai IR (2006) Laparoscopic versus open appendectomy for perforated appendicitis. J Gastrointest Surg 10(6):906–910PubMedCrossRefGoogle Scholar
  15. 15.
    Wullstein C, Barkhausen S, Gross E (2001) Results of laparoscopic vs. conventional appendectomy in complicated appendicitis. Dis Colon Rectum 44(11):1700–1705PubMedCrossRefGoogle Scholar
  16. 16.
    Towfigh S, Chen F, Mason R, Katkhouda N, Chan L, Berne T (2006) Laparoscopic appendectomy significantly reduces length of stay for perforated appendicitis. Surg Endosc 20(3):495–499PubMedCrossRefGoogle Scholar
  17. 17.
    Horvath P, Lange J, Bachmann R, Struller F, Konigsrainer A, Zdichavsky M (2017) Comparison of clinical outcome of laparoscopic versus open appendectomy for complicated appendicitis. Surg Endosc 31(1):199–205PubMedCrossRefGoogle Scholar
  18. 18.
    Fukami Y, Hasegawa H, Sakamoto E, Komatsu S, Hiromatsu T (2007) Value of laparoscopic appendectomy in perforated appendicitis. World J Surg 31(1):93–97PubMedCrossRefGoogle Scholar
  19. 19.
    Katsuno G, Nagakari K, Yoshikawa S, Sugiyama K, Fukunaga M (2009) Laparoscopic appendectomy for complicated appendicitis: a comparison with open appendectomy. World J Surg 33(2):208–214PubMedCrossRefGoogle Scholar
  20. 20.
    Yau KK, Siu WT, Tang CN, Yang GP, Li MK (2007) Laparoscopic versus open appendectomy for complicated appendicitis. J Am Coll Surg 205(1):60–65PubMedCrossRefGoogle Scholar
  21. 21.
    Galli R, Banz V, Fenner H, Metzger J (2013) Laparoscopic approach in perforated appendicitis: increased incidence of surgical site infection? Surg Endosc 27(8):2928–2933PubMedCrossRefGoogle Scholar
  22. 22.
    Lim SG, Ahn EJ, Kim SY, Chung IY, Park JM, Park SH et al (2011) A clinical comparison of laparoscopic versus open appendectomy for complicated appendicitis. J Korean Soc Coloproctol 27(6):293–297PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Tiwari MM, Reynoso JF, Tsang AW, Oleynikov D (2011) Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis. Ann Surg 254(6):927–932PubMedCrossRefGoogle Scholar
  24. 24.
    Piskun G, Kozik D, Rajpal S, Shaftan G, Fogler R (2001) Comparison of laparoscopic, open, and converted appendectomy for perforated appendicitis. Surg Endosc 15(7):660–662PubMedCrossRefGoogle Scholar
  25. 25.
    Stoltzing H, Thon K (2000) Perforated appendicitis: is laparoscopic operation advisable? Dig Surg 17(6):610–616PubMedCrossRefGoogle Scholar
  26. 26.
    Kirshtein B, Bayme M, Domchik S, Mizrahi S, Lantsberg L (2007) Complicated appendicitis: laparoscopic or conventional surgery? World J Surg 31(4):744–749PubMedCrossRefGoogle Scholar
  27. 27.
    Dimitriou I, Reckmann B, Nephuth O, Betzler M (2013) Single institution’s experience in laparoscopic appendectomy as a suitable therapy for complicated appendicitis. Langenbecks Arch Surg 398(1):147–152PubMedCrossRefGoogle Scholar
  28. 28.
    Sauerland S, Jaschinski T, Neugebauer EA (2010) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 6(10):001546Google Scholar
  29. 29.
    Ge B, Zhao H, Chen Q, Jin W, Liu L, Huang Q (2014) A randomized comparison of gasless laparoscopic appendectomy and conventional laparoscopic appendectomy. World J Emerg Surg 9(1):3PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Garg CP, Vaidya BB, Chengalath MM (2009) Efficacy of laparoscopy in complicated appendicitis. Int J Surg 7(3):250–252PubMedCrossRefGoogle Scholar
  31. 31.
    Markides G, Subar D, Riyad K (2010) Laparoscopic versus open appendectomy in adults with complicated appendicitis: systematic review and meta-analysis. World J Surg 34(9):2026–2040PubMedCrossRefGoogle Scholar
  32. 32.
    Edwards JP, Ho AL, Tee MC, Dixon E, Ball CG (2012) Wound protectors reduce surgical site infection: a meta-analysis of randomized controlled trials. Ann Surg 256(1):53–59PubMedCrossRefGoogle Scholar
  33. 33.
    Evasovich MR, Clark TC, Horattas MC, Holda S, Treen L (1996) Does pneumoperitoneum during laparoscopy increase bacterial translocation? Surg Endosc 10(12):1176–1179PubMedCrossRefGoogle Scholar
  34. 34.
    Gurtner GC, Robertson CS, Chung SC, Ling TK, Ip SM, Li AK (1995) Effect of carbon dioxide pneumoperitoneum on bacteraemia and endotoxaemia in an animal model of peritonitis. Br J Surg 82(6):844–848PubMedCrossRefGoogle Scholar
  35. 35.
    Gupta R, Sample C, Bamehriz F, Birch DW (2006) Infectious complications following laparoscopic appendectomy. Can J Surg 49(6):397–400PubMedPubMedCentralGoogle Scholar
  36. 36.
    Reid RI, Dobbs BR, Frizelle FA (1999) Risk factors for post-appendicectomy intra-abdominal abscess. Aust N Z J Surg 69(5):373–374PubMedCrossRefGoogle Scholar
  37. 37.
    Moore CB, Smith RS, Herbertson R, Toevs C (2011) Does use of intraoperative irrigation with open or laparoscopic appendectomy reduce post-operative intra-abdominal abscess? Am Surg 77(1):78–80PubMedGoogle Scholar
  38. 38.
    St Peter SD, Adibe OO, Iqbal CW, Fike FB, Sharp SW, Juang D et al (2012) Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis: a prospective randomized trial. Ann Surg 256(4):581–585PubMedCrossRefGoogle Scholar
  39. 39.
    Tuggle KR, Ortega G, Bolorunduro OB, Oyetunji TA, Alexander R, Turner PL et al (2010) Laparoscopic versus open appendectomy in complicated appendicitis: a review of the NSQIP database. J Surg Res 163(2):225–228PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Medical Research InstituteAlexandria UniversityHadaraEgypt
  2. 2.Faculty of MedicineAlexandria UniversityAlexandriaEgypt
  3. 3.Petroleum HospitalAlexandriaEgypt
  4. 4.Mabaret Alasafra HospitalsAlexandriaEgypt

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