title: Laparoscopic versus open appendectomy for complicated appendicitis in high risk patients.
abstract: BACKGROUND
  Laparoscopic appendectomy is widely used for the treatment of complicated appendicitis. Its use in patients with high operative risk is still on debate. The aim of the presented study was to investigate the benefits of laparoscopic appendectomy in patients with high peri- and postoperative risk factors.
  
  
  METHODS
  We performed a retrospective analysis of all patients who underwent appendectomy in our center between 2006 and 2013. Patients were classified according to their preoperative risk (classification of the American Society of Anesthesia--ASA score). Only patients with ASA 3 and 4 were included and were divided into two groups--open appendectomy (OA group) and laparoscopic appendectomy (LA group).
  
  
  RESULTS
  The operation time was slightly longer in the LA group (p = 0.05), but hospital stay was shorter (p = 0.05). Complications graded according to the Clavien Dindo classification were slightly more frequent in patients after LA, whereas severe complications occurred more frequently in patients after OA (p = 0.01). The postoperative WBC decreased steadily and significantly in patients after OA, whereas the decrease in patients after LA was delayed (p = 0.03). CRP slightly increased after OA and decreased thereafter, whereas it steadily decreased after LA (p = 0.05).
  
  
  CONCLUSIONS
  Laparoscopic appendectomy can be recommended for patients with complicated appendicitis even with higher risk categories.
authors.affiliation: Department of Surgery, Division for General Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Werkgartner
authors.forename: H
authors.initials: H
authors.lastname: Cerwenka
authors.forename: A
authors.initials: A
authors.lastname: El Shabrawi
authors.forename: H
authors.initials: H
authors.lastname: Bacher
authors.forename: H
authors.initials: H
authors.lastname: Hauser
authors.forename: H J
authors.initials: HJ
authors.lastname: Mischinger
authors.forename: M
authors.initials: M
authors.lastname: Wagner
authors.forename: D
authors.initials: D
authors.lastname: Wagner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods*; D001064:Appendicitis / Q000150:complications / Q000601:surgery*; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D007249:Inflammation / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein