title: Single institution's experience in laparoscopic appendectomy as a suitable therapy for complicated appendicitis.
abstract: OBJECTIVE
  Although laparoscopic appendectomy (LA) for acute appendicitis (AA) is widely performed, the value of LA for the treatment of complicated appendicitis (CA) is still controversially discussed.
  
  
  METHODS
  In a retrospective study, we analyzed the clinical records of 404 patients who underwent LA or conversion (intention-to-treat group) or open appendectomy (OA) for AA or CA at the Alfried Krupp Hospital Essen-Rüttenscheid, Germany between January 2007 and December 2010.
  
  
  RESULTS
  AA was treated in 64.2 % by LA and in 35.8 % by OA; the LA-to-OA conversion rate amounts to 3.7 %. CA was treated in 56 % by LA and in 44 % by OA. The LA-to-OA conversion rate here is 13.1 %, and compared to AA, it is significantly (P < 0.01) higher. Comparing LA with OA in both patient groups, we find no significant difference in the overall complication rate, the rate of postoperative intraabdominal abscesses and postoperative ileus. However, in both patient groups, the wound infection rate was significantly lower in patients who had undergone LA (AA P < 0.05 versus CA P < 0.01). In contrast to patients suffering from AA, patients with CA needed significantly less resurgery when treated by LA as compared to OA (P < 0.001). While the duration of surgery for the treatment of AA and CA was similar, the hospitalization time was significantly shorter with LA than with OA (AA P < 0.05 versus CA P < 0.001).
  
  
  CONCLUSIONS
  The data suggest that LA is advantageous not only in the treatment of AA, but also in the therapy of CA. Thus, LA may become a proper and safe routine method if performed by an experienced surgeon.
authors.affiliation: Department of Surgery I, Alfried Krupp Hospital Essen-Rüttenscheid, Alfried-Krupp-Straße 21, 45131 Essen, Germany. ioannis.dimitriou@krupp-krankenhaus.de
authors.forename: Ioannis
authors.initials: I
authors.lastname: Dimitriou
authors.forename: Benjamin
authors.initials: B
authors.lastname: Reckmann
authors.forename: Olaf
authors.initials: O
authors.lastname: Nephuth
authors.forename: Michael
authors.initials: M
authors.lastname: Betzler
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000150:complications* / Q000601:surgery*; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D045823:Ileus / Q000209:etiology / Q000601:surgery; D057194:Intention to Treat Analysis; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery; D055815:Young Adult