Perforated appendicitis: Is early laparoscopic appendectomy appropriate?

Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA.
Surgery (Impact Factor: 3.38). 10/2009; 146(4):731-7; discussion 737-8. DOI: 10.1016/j.surg.2009.06.053
Source: PubMed


Laparoscopic appendectomy for nonperforated appendicitis is associated with improved outcomes; however, laparoscopy has been challenged for perforated appendicitis owing to higher morbidity compared with open or staged procedures. The purpose of this study was to determine whether the laparoscopic approach for perforated appendicitis results in improved outcomes compared with open appendectomy.
Postoperative patient records for confirmed perforated appendicitis from 2005 to 2008 were reviewed retrospectively. Demographics, surgical approach, conversion rate, and outcomes were tabulated, including length of stay (LOS), intra-abdominal and wound infections, and duration of antibiotic therapy.
The incidence of perforation was 27.9% in 885 total patients. The conversion rate from laparoscopic to open for perforated appendicitis was 16%. Hospital LOS was significantly lower in the laparoscopic group (P < .05). The incidence of postoperative abscess was not significantly different; however, the incidence of wound infection and duration of antibiotic therapy were significantly lower in the laparoscopic group (P < .05).
Successful laparoscopic appendectomy reduces LOS, antibiotic therapy, and wound infections compared with open appendectomy in perforated appendicitis without increasing the incidence of postoperative abscess. We conclude that perforated appendicitis can be managed effectively by laparoscopic appendectomy in a high percentage of patients with improved outcomes compared with open appendectomy.

17 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: We present a first principles method to study electronic transport through atomic-scale systems under non-equilibrium conditions. The method is based on density functional theory, and allows the calculation of the response of the system to an applied finite potential difference. The potential drop profile, induced electronic current, nonlinear current-voltage characteristics, and the resulting forces on the atoms are obtained from first principles. The method allows us to take explicitly into account the atomic structure of both the contact region and the semiinfinite electrodes through which the potential is applied. Non-equilibrium Green's functions techniques are used to calculate the quantum conductance. Here we apply the method to the study of the electronic transport in finite carbon nanotubes in contact to gold electrodes.
    Advances in Quantum Chemistry 12/2003; 42(42):299-314. DOI:10.1016/S0065-3276(03)42057-1 · 1.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Many authors emphasize the advantages of laparoscopic techniques in their experience, including the excellent cosmetic results, reduced postoperative pain, rapid functional recovery, lower incidence of adhesions, wound infections and believe that laparoscopic appendectomy is a reliable operation for treating acute appendicitis. Laparoscopic appendectomy has become a standard procedure in the treatment of acute appendicitis in our department since it was introduced in 2003. There are 414 patients underwent laparoscopic appendectomy and 37 patients underwent open appendectomy in our department in 2008. More than 2000 laparoscopic appendectomies were performed in our department during 2003-2009. However, open appendectomy is still the standard procedure in many Taiwan and worldwide hospitals. One of the reasons is that the operating costs incurred for laparoscopic appendectomy are higher than that of open appendectomy. We describe, herein, an access technique utilizing existing instrumentation that is reliable and easy.
    International Journal of Surgery (London, England) 12/2009; 8(2):140-3. DOI:10.1016/j.ijsu.2009.11.013 · 1.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To establish the relationship between operative approach (laparoscopic or open) and subsequent surgical infection (both incisional and organ space infection) postappendectomy, independent of potential confounding factors. Although laparoscopic appendectomy has been associated with lower rates of incisional infections than an open approach, the relationship between laparoscopy and organ space infection (OSI) is not as clearly established. Cases of appendectomy were retrieved from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for 2005 to 2008. Patient factors, operative variables, and the primary outcomes of incisional infections and OSIs were recorded. Factors associated with surgical infections were identified using logistic regression models. These models were then used to calculate probabilities of OSI in clinical vignettes demonstrating varying levels of infectious risk. A total of 39,950 appendectomy cases were included of which 30,575 (77%) were performed laparoscopically. On multivariate analysis, laparoscopy was associated with a lower risk of incisional infection [odds ratio (OR) 0.37, 95% confidence interval (CI) 0.32-0.43] but with an increased risk of OSI after adjustment for confounding factors (OR 1.44, 95% CI 1.21-1.73). For a low-risk patient, probability of OSI was calculated to be 0.3% and 0.4%, respectively, for open versus laparoscopic appendectomy, whereas for a high-risk patient, probabilities were estimated at 8.9% and 12.3%, respectively. Laparoscopy was associated with a decreased risk of incisional infection but with an increased risk of OSI. The degree of this increased risk varies depending on the clinical profile of a surgical patient. Recognition of these differences in risk may aid clinicians in the choice of operative approach for appendectomy.
    Annals of surgery 12/2010; 252(6):895-900. DOI:10.1097/SLA.0b013e3181f194fe · 8.33 Impact Factor
Show more

Similar Publications