Management of Complicated Appendicitis: Is Laparo-endoscopic Single Site Surgery (less) a Safe Option?

Fernando Arias, MD, FACS, Natalia Cortes, MD, Marcos E Pozo, MD, Adolfo Torres, MD, Gabriel Herrera-Almario, MD. University Hospital Fundacion Santa Fe de Bogota; Bogota, Colombia.

INTRODUCTION: Laparoscopic appendectomy is becoming the mainstay of treatment for acute appendicitis. However it remains controversial in cases of complicated appendicitis due to conflicting data in the literature regarding postoperative complications. The purpose of this study is to report the outcomes of patients with complicated appendicitis who underwent LESS appendectomy.

METHODS AND PROCEDURES: We conducted a retrospective review of all patients who underwent LESS appendectomy between July 2008 and September 2013. Complicated appendicitis was categorized in four groups: phlegmon, localized peritonitis, diffuse peritonitis and appendiceal mass. The same surgical team performed all procedures with standard technique. Records were reviewed for demographic data, operative time, intraoperative findings, onset of diet, length of hospital stay, drain requirement, postoperative pain, postoperative complications, cosmetic results and readmissions at 30 days.

RESULTS: A total of 247 patients who underwent LESS appendectomy were included in our analysis. Sixty-three patients (25.50%) met the definition for complicated appendicitis: 32 (50.79%) with phlegmon, 24 (38.10%) with localized peritonitis, 6 (6.35%) with diffuse peritonitis, and 1 (1.59%) with appendiceal inflammatory mass who presented with 1 month of symptoms. There were no conversions to multiport or open surgery. Both operative time and hospital stay were positively correlated with the severity of intraoperative findings. More than half of patients (32 cases, 53.97%) were left with a drain. We registered 1 (2.17%) readmission due to postoperative ileus 24 hours after being discharged. There were only 2 (4.34%) deep abscesses in this series.

CONCLUSION(S): The management of complicated appendicitis and the surgical technique of choice is still a matter of debate. In our series we describe a group of patients with complicated appendicitis managed through a LESS approach with postoperative complications comparable to multiport and open appendectomy. In addition, this technique is associated with short hospital stay, less postoperative pain and excellent cosmetic results and no conversions. Based on these results LESS appendectomy is a safe and feasible option in complicated appendicitis and should be considered in all cases.

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