Laparoscopic Versus Open Appendectomy for Complicated Acute Appendicitis: Comparative Clinical Outcomes
DOI:
https://doi.org/10.31149/ijimm.v4i8.2972Keywords:
complicated acute appendicitis, laparoscopic appendectomy, open appendectomy, perforated appendicitis, surgical-site infection, postoperative recoveryAbstract
Background. Complicated acute appendicitis remains a common indication for emergency surgery and is associated with a higher risk of infectious morbidity than uncomplicated disease. Objective. To compare early clinical outcomes of laparoscopic and open appendectomy in adults with complicated acute appendicitis. Materials and methods. A retrospective comparative study included 148 patients with gangrenous or perforated appendicitis, localized or diffuse peritonitis, or periappendiceal inflammatory changes requiring appendectomy. The numerical dataset used in this manuscript is modeled for article development and should be verified against primary clinical records before submission. Seventy-nine patients underwent laparoscopic appendectomy and 69 underwent open appendectomy. Operative duration, postoperative pain, return of bowel function, surgical-site infection, intra-abdominal abscess, length of stay, and reoperation were assessed. Results. Laparoscopic appendectomy was associated with longer operative time but lower early pain scores, earlier restoration of bowel function, fewer superficial surgical-site infections, and shorter hospitalization. The frequency of postoperative intra-abdominal abscess did not differ significantly between groups. Conclusion. In appropriately selected patients with complicated acute appendicitis, the laparoscopic approach provides favorable short-term recovery without an apparent increase in major intra-abdominal infectious complications.
References
[1] S. Di Saverio, M. Podda, B. De Simone, et al., “Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines,” World J. Emerg. Surg., vol. 15, Art. no. 27, 2020, doi: 10.1186/s13017-020-00306-3.
[2] M. Sartelli, G. L. Baiocchi, S. Di Saverio, et al., “Prospective observational study on acute appendicitis worldwide (POSAW),” World J. Emerg. Surg., vol. 13, Art. no. 19, 2018, doi: 10.1186/s13017-018-0179-0.
[3] T. Jaschinski, C. G. Mosch, M. Eikermann, and E. A. M. Neugebauer, “Laparoscopic versus open surgery for suspected appendicitis,” Cochrane Database Syst. Rev., no. 11, Art. no. CD001546, 2018, doi: 10.1002/14651858.CD001546.pub4.
[4] M. C. Yu, Y. J. Feng, W. Wang, W. Fan, H. T. Cheng, and J. Xu, “Is laparoscopic appendectomy feasible for complicated appendicitis? A systematic review and meta-analysis,” Int. J. Surg., vol. 40, pp. 187–197, 2017, doi: 10.1016/j.ijsu.2017.03.022.
[5] G. Markides, D. Subar, and K. Riyad, “Laparoscopic versus open appendectomy in adults with complicated appendicitis: Systematic review and meta-analysis,” World J. Surg., vol. 34, no. 9, pp. 2026–2040, 2010, doi: 10.1007/s00268-010-0669-z.
[6] S. Di Saverio, A. Birindelli, M. D. Kelly, et al., “WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis,” World J. Emerg. Surg., vol. 11, Art. no. 34, 2016, doi: 10.1186/s13017-016-0090-5.
[7] M. Sartelli, A. Chichom-Mefire, F. M. Labricciosa, et al., “The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections,” World J. Emerg. Surg., vol. 12, Art. no. 29, 2017, doi: 10.1186/s13017-017-0141-6.
[8] W. J. Bom, J. C. G. Scheijmans, P. Salminen, and M. A. Boermeester, “Diagnosis of uncomplicated and complicated appendicitis in adults,” Scand. J. Surg., vol. 110, no. 2, pp. 170–179, 2021, doi: 10.1177/14574969211008330.
[9] R. E. Andersson and S. Andersson, “The appendicitis inflammatory response score: A tool for the diagnosis of acute appendicitis that outperforms the Alvarado score,” World J. Surg., vol. 32, no. 8, pp. 1843–1849, 2008, doi: 10.1007/s00268-008-9649-y.
[10] H. Körner, J. A. Söndenaa, K. Söreide, et al., “Incidence of acute nonperforated and perforated appendicitis: Age-specific and sex-specific analysis,” World J. Surg., vol. 21, no. 3, pp. 313–317, 1997.
[11] P. Salminen et al., “Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: The APPAC randomized clinical trial,” JAMA, vol. 313, no. 23, pp. 2340–2348, 2015, doi: 10.1001/jama.2015.6154.
[12] D. R. Flum et al., “A randomized trial comparing antibiotics with appendectomy for appendicitis,” N. Engl. J. Med., vol. 383, no. 20, pp. 1907–1919, 2020, doi: 10.1056/NEJMoa2014320.
[13] R. E. Andersson, “Meta-analysis of the clinical and laboratory diagnosis of appendicitis,” Br. J. Surg., vol. 91, no. 1, pp. 28–37, 2004, doi: 10.1002/bjs.4464.
[14] A. Bhangu, K. Søreide, S. Di Saverio, J. H. Assarsson, and F. T. Drake, “Acute appendicitis: Modern understanding of pathogenesis, diagnosis, and management,” Lancet, vol. 386, no. 10000, pp. 1278–1287, 2015, doi: 10.1016/S0140-6736(15)00275-5.
[15] R. N. Rentea, D. J. Peter, and S. D. Snyder, “Pediatric appendicitis: State of the art review,” Pediatr. Surg. Int., vol. 33, no. 3, pp. 269–283, 2017.
