Laparoscopic Versus Open Appendectomy for Complicated Appendicitis: Tertiary Care Expereince

Ravinder Pal Singh Babra, MS, FMAS, Jaspal Singh Selhi, MSDNB, Atul Mishra, MS, Ashish Ahuja, MS, Ashwind Bawa, MS. Dayanand Medical College & Hospital Ludhiana Punjab India.

Introduction: Laparoscopic appendectomy (LA) has been an established treatment method for uncomplicated acute appendicitis. Still large numbers of surgeons feel confused regarding the superiority of either laparoscopic or open technique for the treatment of complicated appendicitis. The role of laparoscopy in management of complicated appendicitis ie gangrenous, perforated appendicitis and appendiceal abscess remain undefined. A retrospective study was conducted to review the feasibility, safety and efficacy of laparoscopic appendectomy for patients with complicated appendicitis.

Method and Procedures: From Jan 2008 to Dec 2012 patients older than 14 years of age with diagnosis of appendicitis were included. All patients underwent diagnostic laparoscopy to confirm the diagnosis of complicated appendicitis and patients subsequently underwent either laparoscopic or open appendectomies. Total of 114 patients had undergone appendectomy for perforated or gangrenous appendicitis (75 were males and 39 females). Sixty four patients underwent open appendectomies (OA) and fifty underwent laparoscopic appendectomies. Parameters studied were operative time, conversion rate, wound infection, intra abdominal abscess, duration of pain and hospital stay.

Result: It was seen that laparoscopic appendectomy took longer to perform (110 min versus 80 min) but was associated with less analgesic use, shorter median hospital stay (LA -3 days, OA -6 days), lower rate of wound infection (LA 9.1% , OA 25%). Intra abdominal abscess occurred in four patients in laparoscopic appendectomy group and 15 patients in open appendectomy group. Prolonged ileus was seen more in open appendectomy group as compared to laparoscopic group. There was no mortality in either group.

Conclusion: Minimal invasive laparoscopic technique is safe and efficacious. It is associated with less post operative pain, lower incidence of wound infection and reduced length of hospital stay as compared to patients who underwent open appendectomy.

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