Laparoscopy should be the approach of choice for acute appendicitis in the morbidly obese.
BACKGROUND
The current study compared the outcome of morbidly obese patients undergoing laparoscopic versus open appendectomy.


METHODS
We obtained data from the University HealthSystem Consortium (UHC) database on 1,943 morbidly obese patients who underwent appendectomy for acute or perforated appendicitis between 2002 and 2007.


RESULTS
Compared to open appendectomy, laparoscopic appendectomy was associated with a shorter length of stay (3 vs 4 days) and a lower overall complication rate (9% vs 17%). Most notably, a lower rate of wound infection was noted (1% vs 3%). Within a subset analysis of morbidly obese patients who underwent appendectomy for perforated appendicitis, there was a higher overall complication rate (27% vs 18%) and cost ($16,600 vs $12,300) in the open appendectomy group.


CONCLUSIONS
In the morbidly obese, laparoscopic appendectomy performed for acute and perforated appendicitis is associated with a shorter length of stay and lower morbidity and costs. Laparoscopic appendectomy should be the procedure of choice for the treatment of acute appendicitis in the morbidly obese population.
Department of Surgery, University of Texas Southwestern, Dallas, TX, USA. esteban.varela@utsouthwestern.edu
J Esteban
JE
Varela
Marcelo W
MW
Hinojosa
Ninh T
NT
Nguyen
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000191:economics / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D003657:Decision Making; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology; D012720:Severity of Illness Index