Laparoscopic management of complicated appendicitis.

Wael N Abdelsalam, MD, Khaled M Katri, MD, Galal M Abouelnagah, MD, Mohamed K Elsaidy, MD, Aly Atteya, MD, Elsaid Elkayal, MD, Mustafa Gamal, MRCS, Mohamed Sharaan, MD, Tamer N Abdelbaki, MD. University of Alexandria Faculty of Medicine.

Complicated appendicitis is defined as acute appendicitis in which perforation or an intra-abdominal abscess is present. It occurs in 20% to 30% of acute appendicitis patients and is associated with much higher risks of postoperative complications. We herein study the safety, feasibility and post operative outcome of laparoscopic management of complicated appendicitis.

Material & Methods:
During the period from January 2010 till the end of June 2013, all patients who underwent laparoscopic appendectomy (LA) for complicated appendicitis were included. Patient’s demographics, diagnostic procedure, operative and post operative data were analyzed.

Forty eight patients were included, with a male to female ratio 39:9. Fourteen patients (29.2%) had complicated appendicitis at the time of diagnosis. Mean age was 27.13±11.13. Eleven patients (22.9%) were diagnosed preoperatively as complicated appendicitis by CT or ultrasound, while 3 patients were diagnosed intraoperatively. Mean operative time was higher in patients with complicated appendicitis compared to uncomplicated ones 91.8±53.83 minutes vs 68.3±24.2 minutes (p>0.05). All appendectomies were completed laparoscopicaly except for one patient who was converted to open technique. Post operative course was uneventful except for 4 patients (8.3%), where 2 of them had a residual abscess at resection bed, one required percutaneous drainage while the other was managed conservatively. One patient suffered from a low output fecal fistula that resolved spontaneously and one patient was a female in her 1st trimester whose complicated appendicitis was managed successfully but she had an abortion 3 days later.

laparoscopic management of complicated appendicitis can be safe and feasible.

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