Laparoscopic Versus Open Approach in the Management of Appendicitis Complicated With Peritonitis

Felipe Quezada, MD, Ricardo Mejia, MD, Nicolas Quezada, MD, Oslando Padilla, Alex Escalona, MD, Nicolas Jarufe, MD, Fernando Pimentel, MD. Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.


INTRODUCTION: In the last few years, laparoscopy has become the standard of care in most of abdominal surgical pathologies. Laparoscopic appendectomy (LA) has demonstrated to be a safe approach in cases of non-complicated appendicitis; however, controversial evidence exists regarding the laparoscopic management of patients with ongoing appendicitis complicated with peritonitis (ACP).
The aim of the present study was to compare short and long term post-operatory outcomes in patients with ACP managed with LA or open appendectomy (OA) in our institution.

MATERIALS AND METHODS: We conducted a retrospective analysis of the clinical records of patients with ACP operated from January 2003 until July 2011 in our center. Demographic data, comorbidities, intra-operative variables, length of stay, surgical complications, operative mortality, readmissions and reoperations were recorded. Analysis was made using IBM® SPSS® Statistics v.19.0.

RESULTS: A total of 160 patients were identified: 63,1% were males, mean age 38 ± 17,2 years (range from 12 to 85 years) and 33,1% had associated comorbidities.  Forty-four patients (27,5%) underwent LA, 11 (25%) of which were converted to OA. There were a total of 58 patients (36,3%) with diffuse peritonitis: 43,2% in the LA group and 33,6% in the OA group (p=NS). LA was associated to a longer operative time (LA: 93 ± 43,8 vs OA: 68,4 ± 30,3 minutes p=0,005). No differences were recorded in length of hospital stay (LA: 4,9 ± 2,8 days vs OA: 5,6 ± 4,5 days, p=0,34).
A total of 33 patients (20,6%) presented a postoperative complication. There were no differences in the rate of surgical site infections (LA: 4,5% vs OA: 6%, p=NS), prolonged post-operatory ileus (LA: 2,3% vs OA: 6%, p=0,44), or postoperative intra-abdominal abscesses (IAA) (LA: 6,8% vs OA: 1,7%, p=0,13). Two patients with IAA in the LA group were managed laparoscopically.
There were 6 hospital readmissions in the OA group, all of them required a surgical intervention: 3 mechanical ileus, 2 incisional hernias and 1 evisceration. No readmissions were found in the LA group.
Two patients (1,3%) died during hospitalization due to abdominal septic shock, both in the OA group.

CONCLUSIONS: In our study a trend to higher late postoperative complications as readmissions and reoperations was seen in the OA group, while LA tended to have more IAA. Overall, LA showed comparable postoperatory outcomes to OA in the management of ACP.

Session Number: Poster – Poster Presentations
Program Number: P546
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