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Surgical Endoscopy

, Volume 31, Issue 1, pp 199–205 | Cite as

Comparison of clinical outcome of laparoscopic versus open appendectomy for complicated appendicitis

  • P. HorvathEmail author
  • J. Lange
  • R. Bachmann
  • F. Struller
  • A. Königsrainer
  • M. Zdichavsky
Article

Abstract

Background

Laparoscopic appendectomy is now the treatment of choice in uncomplicated appendicitis. To date its importance in the treatment of complicated appendicitis is not clearly defined.

Methods

From January 2005 to June 2013 a total of 1762 patients underwent appendectomy for the suspected diagnosis of appendicitis at our institution. Of these patients 1516 suffered from complicated appendicitis and were enrolled. In total 926 (61 %) underwent open appendectomy (OA) and 590 (39 %) underwent laparoscopic appendectomy (LA). The following parameters were retrospectively analyzed: age, sex, operative times, histology, length of hospital stay, 30-day morbidity focusing on occurrence of surgical site infections, intraabdominal abscess formation, postoperative ileus and appendiceal stump insufficiency, conversion rate, use of endoloops and endostapler.

Results

A statistically significant difference in operative time was observed between the laparoscopic and the open group (64.5 vs. 60 min; p = 0.002). Median length of hospitalization was significantly shorter in the laparoscopic group (p < 0.000). Surgical site infections occurred exclusively after OA (38 vs. 0 patients). Intraabdominal abscess formation occurred statistically significantly more often after LA (2 vs. 10 patients; p = 0.002). There were no statistical significances concerning the occurrence of postoperative ileus (p = 0.261) or appendiceal stump insufficiencies (p = 0.076).

Conclusions

The laparoscopic approach for complicated appendicitis is a safe and feasible procedure. Surgeons should be aware of a potentially higher incidence of intraabdominal abscess formation following LA. Use of endobags , inversion of the appendiceal stump and carefully conducted local irrigation of the abdomen in a supine position may reduce the incidence of abscess formation.

Keywords

Complicated Appendicitis Laparoscopy Intraabdominal abscess 

Notes

Compliance with ethical standards

Disclosures

Dr. Philipp Horvath, Dr. Jessica Lange, Dr. Robert Bachmann, Dr. Florian Struller, Dr. Alfred Königsrainer and Dr. Marty Zdichavsky have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • P. Horvath
    • 1
    Email author
  • J. Lange
    • 1
  • R. Bachmann
    • 1
  • F. Struller
    • 1
  • A. Königsrainer
    • 1
  • M. Zdichavsky
    • 1
  1. 1.Department of General, Visceral and Transplant Surgery, Comprehensive Cancer CenterUniversity of TübingenTübingenGermany

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