title: Laparoscopic versus open approach in the management of appendicitis complicated exclusively with peritonitis: a single center experience.
abstract: BACKGROUND
  Controversial evidence exists regarding the laparoscopic approach in patients with acute appendicitis complicated with peritonitis due to a higher rate of surgical complications. The aim of this study was to compare post-operatory outcomes in patients with acute appendicitis complicated exclusively with peritonitis approached by laparoscopy versus open surgery.
  
  
  METHODS
  Single center retrospective analysis of clinical records of patients with appendicitis complicated with peritonitis operated from January 2003 until October 2013. Demographic data, intra-operative variables, length of stay, surgical complications, mortality, readmissions and reoperations were retrieved.
  
  
  RESULTS
  227 patients were identified, 43% males, mean age 39±17 years (range: 12-85 years). Ninety-seven patients (43%) underwent laparoscopic appendectomy, 13 of them were converted to open surgery (13%). Ninety-four patients presented with diffuse peritonitis (41.4%). Laparoscopic appendectomy showed longer operative time but shorter hospital stay (p<0.05). There were no differences in post-operatory complications (intra-abdominal abscess, surgical site infection and prolonged ileus). Laparoscopic appendectomy was associated with lower odds for developing any surgical complication in the multivariate analysis (OR 0.301, p=0.036).
  
  
  CONCLUSIONS
  Both approaches showed no differences in complications in the management of appendicitis complicated exclusively with peritonitis. In our experience, laparoscopic appendectomy is a safe approach in cases of appendicitis complicated exclusively with peritonitis.
authors.affiliation: Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Felipe
authors.initials: F
authors.lastname: Quezada
authors.affiliation: Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. Electronic address: nfquezada@gmail.com.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Quezada
authors.affiliation: Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Mejia
authors.affiliation: Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Brañes
authors.affiliation: Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Oslando
authors.initials: O
authors.lastname: Padilla
authors.affiliation: Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Jarufe
authors.affiliation: Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Fernando
authors.initials: F
authors.lastname: Pimentel
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods*; D001064:Appendicitis / Q000150:complications* / Q000601:surgery*; D002648:Child; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D045823:Ileus / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D061646:Operative Time; D010538:Peritonitis / Q000209:etiology*; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D055815:Young Adult
keywords: Abdominal abscess; Appendicitis; Laparoscopy; Peritonitis