Objective: This study aims to know which access is chosen in case of appendicitis with localised or diffused peritonitis and to evaluate the intra operative and postoperative complications.
Technique: Prospective analysis including all patients admitted with appendicular peritonitis. Open appendectomy is undertaken through iliac or midline laparotomy. Laparoscopic appendectomy is undertaken through 3 or 4 trocars.
Patients: Between 1997 and 2007, 255 patients were included. Diffused pain was found in 15% and diffused guarding in 6.7% of the cases. Appendectomy was undertaken under laparoscopy (41.9%), laparoscopy converted to laparotomy (7.1%), through midline laparotomy (5.1%), iliac laparotomy because of the condition of the patient (23.5%) and because it was the choice of the team (21.9%).
Results: During laparoscopic appendectomy because of periappendicular abscess (13.1%) localised peritonitis (81.3%) diffused peritonitis (11.2%), 10.3% of the patients suffered from intra operative complications. During the postoperative period, 6.6% of the patients suffered from postoperative complications and 3.7% were reoperated. During open appendectomy because of periappendicular abscess (42.6%), localised peritonitis (64.2%), diffused peritonitis (6.8%) with retroperitoneal cellulitis (6.1%), 8.8% of the patients suffered from intra operative complications. During the postoperative period, 26.3% of the patients suffered from local complications, 9.8% from general complications and 15.5% were reoperated.
Conclusion: Intra operative complications were more frequent under laparoscopy undertaken in 41.9% of the cases. Postoperative complications and reoperations were more frequent after open appendectomy, probably because of the high frequency of periappendicular abscess and retroperitoneal cellulitis.
Program Number: P087