Laparoscopic appendectomy for perforated appendicitis: a comparison with open appendectomy

Background: Perforated appendix in diabetic as well as hypertensive patients is associated with elevated risks of postoperative infectious complications such as wound infection and intra-abdominal abscess. Objective: To identify better appendectomy procedure for diabetic and hypertensive patients. Study Design: Randomized Controlled Trial Place and Duration of Study: Department of Surgery, Unit l, Bahawal Victoria Hospital Bahawalpur from 10th October 2020 to 9th April 2021. Methodology: Ninety eight patients meeting the criteria of perforated appendix were divided in two groups; one group consisted of 49 patients who were managed by open surgical procedure. Second group was consisted of 49 patients who were managed by laparoscopic surgical procedure. Patient outcomes in-terms of wound infections, operative time and duration of surgery was assessed. Results: Mean age of patients was 25.49±6.03 years. There were 17 hypertensive while 15 diabetic patients. Wound infection was seen in 21% and 28% open surgery diabetic and hypertensive patients respectively in comparison to 10%and 8% in laparoscopic appendectomy diabetic and hypertensive patients respectively (p<0.001). Conclusion: Laparoscopic appendectomy (LA) is associated with significantly lower rates of post-operative wound infections and shorter hospital stay in comparison to open appendectomy in diabetic and hypertensive patients of perforated appendicitis. Key Words: Perforated appendix, laparoscopic, open appendectomy

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Advantages of Laparoscopic Appendectomy in the Elderly

The American Surgeon ◽

10.1177/000313480607200603 ◽

2006 ◽

Vol 72 (6) ◽

pp. 474-480 ◽

Cited By ~ 18

Author(s):

Andrew G. Harrell ◽

Amy E. Lincourt ◽

Yuri W. Novitsky ◽

Michael J. Rosen ◽

Timothy S. Kuwada ◽

...

Keyword(s):

Elderly Patients ◽

Laparoscopic Appendectomy ◽

Open Appendectomy ◽

Perforated Appendicitis ◽

Laparoscopic Approach ◽

The Elderly ◽

Adult Patients ◽

Perioperative Outcomes ◽

Skilled Nursing ◽

Total Charges

Laparoscopic appendectomy (LA) has gained in popularity in recent years. The number of elderly patients undergoing appendectomy has increased as that segment of the population has increased in number; however, the utility and benefits of LA in the elderly population are not well established. We hypothesized that LA in the elderly has distinctive advantages in perioperative outcomes over open appendectomy (OA). We queried the 1997 to 2003 North Carolina Hospital Association Patient Data System for all patients with the primary ICD-9 procedure code for OA and LA. Patients ≥65 years of age (elderly) were identified and reviewed. Outcomes including length of stay (LOS), charges, complications, discharge location, and mortality were compared between the groups. There were 29,244 appendectomies performed in adult patients (>18 years old) with 2,722 of these in the elderly. The annual percentage of LA performed in the elderly increased from 1997 to 2003 (11.9–26.9%, P < 0.0001). When compared with OA, elderly patients undergoing LA had a shorter LOS (4.6 vs 7.3 days, P = 0.0001), a higher rate of discharge to home (91.4 vs 78.9%, P = 0.0001) as opposed to a step-down facility, fewer complications (13.0 vs 22.4%, P = 0.0001), and a lower mortality rate (0.4 vs 2.1%, P = 0.007). When LA was compared with OA in elderly patients with perforated appendicitis, LA resulted in a shorter LOS (6.8 vs 9.0 days, P = 0.0001), a higher rate of discharge to home (86.6 vs 70.9%, P = 0.0001), but equivalent total charges ($22,334 vs $23,855, P = 0.93) and mortality (1.0 vs 2.98%, P = 0.10). When elderly patients that underwent LA were compared with adult patients (18–64 years old), they had higher total charges ($16,670 vs $11,160, P = 0.0001) but equivalent mortality (0.37 vs 0.15%, P = 0.20). The use of laparoscopy in the elderly has significantly increased in recent years. In general, the safety and efficacy of LA is demonstrated by a reduction in mortality, complications, and LOS when compared with OA. The laparoscopic approach to the perforated appendix in the elderly patient has advantages over OA in terms of decreased LOS and a higher rate of discharge to home as opposed to rehabilitation centers, nursing homes, or skilled nursing care. When compared with all younger adults, the laparoscopic approach in the elderly was associated with equal mortality rates even though hospitalization charges were higher. Laparoscopy may be the preferred approach in elderly patients who require appendectomy.

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Laparoscopic Appendectomy Trends and Outcomes in the United States: Data from the Nationwide Inpatient Sample (NIS), 2004–2011

The American Surgeon ◽

10.1177/000313481408001035 ◽

2014 ◽

Vol 80 (10) ◽

pp. 1074-1077 ◽

Cited By ~ 44

Author(s):

Hossein Masoomi ◽

Ninh T. Nguyen ◽

Matthew O. Dolich ◽

Steven Mills ◽

Joseph C. Carmichael ◽

...

Keyword(s):

United States ◽

Acute Appendicitis ◽

Laparoscopic Appendectomy ◽

Conversion Rate ◽

Nationwide Inpatient Sample ◽

Open Appendectomy ◽

Perforated Appendicitis ◽

The United States ◽

Hospital Charges ◽

Nationwide Inpatient Sample Database

Laparoscopic appendectomy (LA) is becoming the standard procedure of choice for appendicitis. We aimed to evaluate the frequency and trends of LA for acute appendicitis in the United States and to compare outcomes of LA with open appendectomy (OA). Using the Nationwide Inpatient Sample database, we examined patients who underwent appendectomy for acute appendicitis from 2004 to 2011. A total of 2,593,786 patients underwent appendectomy during this period. Overall, the rate of LA was 60.5 per cent (children: 58.1%; adults: 63%; elderly: 48.7%). LA rate significantly increased from 43.3 per cent in 2004 to 75 per cent in 2011. LA use increased 66 per cent in nonperforated appendicitis versus 100 per cent increase in LA use for perforated appendicitis. The LA rate increased in all age groups. The increased LA use was more significant in male patients (84%) compared with female patients (62%). The overall conversion rate of LA to OA was 6.3 per cent. Compared with OA, LA had a significantly lower complication rate, a lower mortality rate, a shorter mean hospital stay, and lower mean total hospital charges in both nonperforated and perforated appendices. LA has become an established procedure for appendectomy in nonperforated and perforated appendicitis in all rates exceeding OA. Conversion rate is relatively low (6.3%).

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Laparoscopic appendectomy for perforated appendicitis; a comparison with open appendectomy

SVU-International Journal of Medical Sciences ◽

10.21608/svuijm.2020.111986 ◽

2020 ◽

Vol 3 (2) ◽

pp. 69-78

Author(s):

Ziad Abdel Raouf Ismail ◽

Mohammed Abdel Shafy Mohamed ◽

Asmaa Gaber Rizk ◽

Mohamed Yousef Ahmed ◽

Hamdy Mohamed Hussein

Keyword(s):

Laparoscopic Appendectomy ◽

Open Appendectomy ◽

Perforated Appendicitis

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Laparoscopic appendectomy in children - new fashion or privilege

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh04s1090g ◽

2004 ◽

Vol 132 (suppl. 1) ◽

pp. 90-92

Author(s):

Zoran Golubovic ◽

Nenad Janic ◽

Branislav Jovanovic

Keyword(s):

Length Of Stay ◽

Laparoscopic Appendectomy ◽

Pediatric Surgery ◽

Operative Time ◽

Operating Time ◽

Open Appendectomy ◽

Perforated Appendicitis ◽

Surgical Experience ◽

Single Institution ◽

One Year

Whether laparoscopic appendectomy is superior to open appendectomy for simple and perforated appendicitis in children is still debatable. To answer this question, surgical experience of three experienced pediatric surgeons in a single institution was studied during one year in all cases of laparoscopic appendectomy. From January 2003 to January 2004, all laparoscopic appendectomies were reviewed for operative technique, advantages, disadvantages, operative time and length of stay. There were 44 laparoscopic appendectomies in children aged 4 to 19 years. Operating time dropped from 52 minutes at the beginning to less than 25 minutes at the end of year. Operating time in perforated appendicitis was slightly longer, from 58-65 minutes. Length of stay was 1-2 days for simple cases, and maximum 5 days for perforated ones. There were no postoperative complications such as abscess, bowel obstruction, bleeding, wound infection or mortality. Laparoscopic appendectomy is at least as safe and effective, if not superior to, as open appendectomy for both, simple and perforated appendicitis. Postoperative pain is less, and recovery is faster. Laparoscopic appendectomy is our procedure of choice in pediatric surgery.

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Laparoscopic appendectomy for perforated appendicitis in children has complication rates comparable with those of open appendectomy

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2012.07.066 ◽

2013 ◽

Vol 48 (3) ◽

pp. 555-561 ◽

Cited By ~ 24

Author(s):

Mohammad Reza Vahdad ◽

Ralf-Bodo Troebs ◽

Matthias Nissen ◽

Lars Benjamin Burkhardt ◽

Svenja Hardwig ◽

...

Keyword(s):

Laparoscopic Appendectomy ◽

Open Appendectomy ◽

Perforated Appendicitis ◽

Complication Rates

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Comparison of Open Appendectomy and Laparoscopic Appendectomy in Perforated Appendicitis

Cureus ◽

10.7759/cureus.5105 ◽

2019 ◽

Cited By ~ 1

Author(s):

Aamna Nazir ◽

Sarosh Afzal Farooqi ◽

Noman A Chaudhary ◽

Hamza Waqar Bhatti ◽

Mahnoor Waqar ◽

...

Keyword(s):

Laparoscopic Appendectomy ◽

Open Appendectomy ◽

Perforated Appendicitis

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Modern principles of diagnostic and treatment of acute appendicitis in children

Paediatric Surgery Ukraine ◽

10.15574/ps.2021.71.32 ◽

2021 ◽

pp. 32-41

Author(s):

A.A. Pereyaslov ◽

◽

R.V. Stenyk ◽

A.I. Bobak ◽

A.O. Dvorakevych ◽

...

Keyword(s):

Acute Appendicitis ◽

Laparoscopic Appendectomy ◽

Conflicts Of Interest ◽

Open Appendectomy ◽

Perforated Appendicitis ◽

Early Postoperative Period ◽

Plasma Sodium ◽

Laboratory Markers ◽

High Level

Introduction. The typical clinical picture of acute appendicitis (AA) is absent in most of patients, that lead for the high frequency of misdiagnosis with the increase of complicated forms of AA. Due to that, it is necessary to establish the new available laboratory markers, which permitted with the high level of reliability distinguish children not only with AA, but also is appendix perforation. The question what method of appendectomy should be choose – the conventional or mini-invasive – are still under debate. Aim of the study was to summarize the results of diagnosis and treatment of AA in children with the applying of various laboratory markers, ultrasonography (US), and laparoscopy. Materials and methods. This study based on the results of surgical treatment of 3171 children with AA, which were operated during 2009–2018 years. Diagnosis was established on the data of anamnesis, results of objective and laboratory investigation. US was performed in 1183 (37.3%) of patients. Open appendectomy (OA) was performed in 2879 (90.8%) and laparoscopic (LA) – in 292 (9.2%) of patients. With the aim to evaluate the results the methods of variative statistic, determination of specificity, sensitivity, positive (PPV) and negative (NPV) predictive value, etc. were applied. Results. Among the laboratory markers, the best results for the diagnosis of AA showed the neutrophil to lymphocytes ratio (NLR) with the sensitivity – 84.9%, specificity – 67.1%, PPV – 17.8%, and NPV – 98.9%. NLR (sensitivity – 82.5%, specificity – 84%, PPV – 98.5%) and sodium blood level (sensitivity – 90.3%, specificity – 89.9%, PPV – 98.9%) had the best results for the diagnostic of perforated AA. US is the important compound of diagnostic of AA in children with the high level of sensitivity, specificity, PPV, and NPV – 93%, 85%, 86%, and 92%, correspondingly. By the frequency of complications in the early postoperative period, OA and LA had no statistically significant differences, but at follow-up after surgery, LA revealed the sufficient advantages over OA. Conclusions. Among the various laboratory markers, NLR had the better prognostic value for the diagnosis of AA and indices of plasma sodium concentration and NLR for the preoperative diagnosis of perforated appendicitis. US with the high degree of reliability allows to confirm or exclude the diagnosis of AA in children with acute abdominal syndrome. Laparoscopic appendectomy is the real alternative for conventional methods of AA treatment. Besides of the well-known advantages of mini-invasive surgery, the laparoscopic appendectomy had an advantage at the follow-up period. No conflicts of interest was declared by the authors. Key words: acute appendicitis, children, diagnostic, treatment, laparoscopy.

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Peritonitis from Perforated Appendicitis: Stress Response after Laparoscopic or Open Treatment

The American Surgeon ◽

10.1177/000313481207800541 ◽

2012 ◽

Vol 78 (5) ◽

pp. 582-590 ◽

Cited By ~ 14

Author(s):

Mario Schietroma ◽

Federica Piccione ◽

Francesco Carlei ◽

Marco Clementi ◽

Zuleyka Bianchi ◽

...

Keyword(s):

Systemic Inflammation ◽

Laparoscopic Appendectomy ◽

Neutrophil Elastase ◽

Open Appendectomy ◽

Perforated Appendicitis ◽

Laparoscopic Group ◽

Open Group ◽

C Reactive Protein ◽

Reactive Protein ◽

Hla Dr

Elevated intra-abdominal pressure during laparoscopy may promote systemic inflammatory response. In patients with generalized peritonitis from perforated appendicitis, we sought to compare acute phase response and immunologic status from laparoscopic and open approach. One hundred and forty-seven consecutive patients underwent appendectomy for perforated appendicitis (73 patients had laparoscopic appendectomy and 74 patients had open appendectomy. Bacteremia, endotoxemia, white blood cells, peripheral lymphocytes subpopulation, human leukocyte antigen-DR (HLA-DR), neutrophil-elastase, interleukin-1 and 6 (IL-1 and 6), and C-reactive protein were investigated. One hour after intervention, bacteremia was significantly higher in the open group compared with the laparoscopic group ( P < 0.05). A significantly higher concentration of systemic endotoxin was detected intraoperatively in the open group of patients in comparison with the laparoscopic group ( P < 0.05). Laparotomy caused a significant increase in neutrophil concentration, neutrophil-elastase, IL-1 and 6, and C-reactive protein and a decrease of HLA-DR. We recorded 6 cases (8.1%) of intra-abdominal abscess in the open group and one (1.3%) in the laparoscopic group ( P < 0.05). Open appendectomy, in case of peritonitis, increased the incidence of bacteremia, endotoxemia, and systemic inflammation compared with laparoscopic appendectomy. Early enhanced postoperative systemic inflammation may cause lower transient immunologic defense after laparotomy (decrease of HLA-DR), leading to enhanced sepsis in these patients.

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Laparoscopic appendectomy versus antibiotic treatment for acute appendicitis—a systematic review

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03927-5 ◽

2021 ◽

Author(s):

Franziska Köhler ◽

Anne Hendricks ◽

Carolin Kastner ◽

Sophie Müller ◽

Kevin Boerner ◽

...

Keyword(s):

Systematic Review ◽

Antibiotic Therapy ◽

Antibiotic Treatment ◽

Laparoscopic Appendectomy ◽

Data Extraction ◽

Open Appendectomy ◽

Cochrane Library ◽

Pubmed Database ◽

Uncomplicated Appendicitis ◽

Absence From Work

Abstract Background Over the last years, laparoscopic appendectomy has progressively replaced open appendectomy and become the current gold standard treatment for suspected, uncomplicated appendicitis. At the same time, though, it is an ongoing discussion that antibiotic therapy can be an equivalent treatment for patients with uncomplicated appendicitis. The aim of this systematic review was to determine the safety and efficacy of antibiotic therapy and compare it to the laparoscopic appendectomy for acute, uncomplicated appendicitis. Methods The PubMed database, Embase database, and Cochrane library were scanned for studies comparing laparoscopic appendectomy with antibiotic treatment. Two independent reviewers performed the study selection and data extraction. The primary endpoint was defined as successful treatment of appendicitis. Secondary endpoints were pain intensity, duration of hospitalization, absence from work, and incidence of complications. Results No studies were found that exclusively compared laparoscopic appendectomy with antibiotic treatment for acute, uncomplicated appendicitis. Conclusions To date, there are no studies comparing antibiotic treatment to laparoscopic appendectomy for patients with acute uncomplicated appendicitis, thus emphasizing the lack of evidence and need for further investigation.

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