Laparoscopic appendectomy for complicated appendicitis: a comparison with open appendectomy.
BACKGROUND
Although laparoscopic appendectomy (LA) is widely performed in many countries, LA for complicated appendicitis, which includes perforated or gangrenous appendicitis with or without localized or disseminated peritonitis, has not become a common practice yet.


METHODS
We retrospectively analyzed the clinical records of 230 patients who had undergone appendectomy for complicated appendicitis: 141 had undergone LA, 84 had conventional open appendectomy (OA), and 5 patients had conversion to the open procedure after laparoscopy. The LA group (total LA) was subdivided into "early experience (early LA: cases 1-56)" and "late experience (late LA: case 57 and higher)." We defined the early LA group as the comparison group to minimize selection bias.


RESULTS
Patient demographics were similar in the early LA and OA groups (P > 0.05). Wound infection was significantly more frequent in the OA group (P < 0.05). Intra-abdominal infection was equally common in these two groups. The overall rate of postoperative complications was significantly higher in the OA group (32.1%) than in the early LA group (18%; P < 0.05). This incidence was 12.8% in the total LA group. Hospital stay was significantly shorter in the early LA group (10.6 +/- 3.9 days; P < 0.05), and 8.9 +/- 3.7 days in the total LA group.


CONCLUSIONS
Our findings indicate that LA is safe and useful even for the treatment of complicated appendicitis if performed by an experienced surgeon.
Katsuno
Goutaro
G
Department of Surgery, Juntendo Urayasu Hospital, Juntendo University, 2-1-1 Tomioka, Urayasu, 279-0021, Japan. gkatsuno4596@s7.dion.ne.jp
Nagakari
Kunihiko
K
Yoshikawa
Seiichiro
S
Sugiyama
Kazuyoshi
K
Fukunaga
Masaki
M
D000328:Adult; D000704:Analysis of Variance; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000150:complications / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome