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Results of laparoscopicvs. conventional appendectomy in complicated appendicitis

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

BACKGROUND: Although many trials show some advantages of laparoscopic appendectomy over open appendectomy, the value of laparoscopic appendectomy is still controversial. Specifically the question of whether there are benefits of laparoscopic appendectomy over open appendectomy in complicated appendicitis remains to be answered. METHODS: Of 1,106 consecutive appendectomies (717 laparoscopic appendectomies, 330 open appendectomies, and 59 conversions) between 1989 and 1999, the results of 299 patients with complicated appendicitis (defined by perforation, abscess, or peritonitis) were analyzed retrospectively to compare the complications of laparoscopic appendectomy and conversion (intention-to-treat group) with those of open appendectomy. RESULTS: Complicated appendicitis (n=299) was treated by laparoscopic appendectomy in 171 patients, by open appendectomy in 82 patients, and by conversion in 46 patients. Laparoscopic appendectomy and conversion showed fewer abdominal wall complications than open appendectomy (13/217; 6 percentvs. 15/82; 18.3 percent;P<0.003), which led to a decrease of the total complication rate in the intention-to-treat group (21/217; 9.7 percentvs. 19/82; 23.1 percent;P=0.004). The rate of intra-abdominal abscess formation was nearly the same after laparoscopic appendectomy (4.1 percent) and open appendectomy (4.9 percent). The total complication rate was higher in complicated appendicitis than in acute appendicitis (P<0.005) but was independent of the laparoscopic technique. The conversion rate was higher in complicated appendicitis than in acute appendicitis (21.2vs. 2.3 percent;P<0.001). CONCLUSION: In comparison with open appendectomy, laparoscopic appendectomy (by itself and in an intention-to-treat view) leads to a significant reduction of early postoperative complications in complicated appendicitis and therefore should be considered as the procedure of choice.

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References

  1. Frizelle FA. Pelvic abscess following laparoscopic appendectomy. Surg Endosc 1996;10:947–8.

    Article  PubMed  Google Scholar 

  2. Hart R, Rajgopal C, Plewes A,et al. Laparoscopic versus open appendectomy: a prospective randomized trial of 81 patients. Can J Surg 1996;39:457–62.

    PubMed  Google Scholar 

  3. Minne L, Varner D, Burnell A, Ratzer E, Clark J, Haun W. Laparoscopic vs open appendectomy. Arch Surg 1997;132:708–11.

    PubMed  Google Scholar 

  4. Tate JJ, Dawson JW, Chung SC, Lau WY. Laparoscopic versus open appendicectomy: prospective randomized trial. Lancet 1993;342:633–7.

    Article  PubMed  Google Scholar 

  5. Apelgren KN, Molnar RG, Kisala JM. Laparoscopic is not better than open appendectomy. Am Surg 1995;61:240–3.

    PubMed  Google Scholar 

  6. McCahill LE, Pellegrini CA, Wiggins T, Helton WS. A clinical outcome and cost analysis of laparoscopic versus open appendectomy. Am J Surg 1996;171:533–7.

    Article  PubMed  Google Scholar 

  7. Reiertsen O, Larsen S, Trondsen E, Edwin B, Faerden AE, Rosseland AR. Randomized controlled trial with sequential design of laparoscopic versus conventional appendicectomy. Br J Surg 1997;84:842–7.

    Article  PubMed  Google Scholar 

  8. Vallina VL, Velasco JM, McCulloch CS. Laparoscopic versus conventional appendectomy. Ann Surg 1993;218:685–92.

    PubMed  Google Scholar 

  9. Wagner M, Aronsky D, Tschudi J, Metzger A, Klaiber C. Laparoscopic stapler appendectomy. Surg Endosc 1996;10:895–9.

    Article  PubMed  Google Scholar 

  10. Bouillot JL, Salah S, Fernandez F,et al. Laparoscopic procedure for suspected appendicitis. Surg Endosc 1995;9:957–60.

    Article  PubMed  Google Scholar 

  11. Ikard RW, Federspiel CF. Laparoscopic versus open appendectomy. N Engl J Med 1995;333:881–2.

    Article  Google Scholar 

  12. Johnson AB, Peetz ME. Laparoscopic appendectomy is an acceptable alternative for the treatment of perforated appendicitis. Surg Endosc 1998;12:940–3.

    Article  PubMed  Google Scholar 

  13. Kazemier G, de Zeeuw GR, Lange JF, Hop WC, Bonjer HJ. Laparoscopic vs open appendectomy. Surg Endosc 1997;11:336–40.

    Article  PubMed  Google Scholar 

  14. Moberg AC, Ahlberg G, Leijonmarck CE,et al. Diagnostic laparoscopy in 1043 patients with suspected acute appendicitis. Eur J Surg 1998;164:833–40.

    Article  PubMed  Google Scholar 

  15. Schroder DM, Lathrop JC, Lloyd LR, Boccaccio JE, Hawasli A. Laparoscopic appendectomy for acute appendicitis: is there really a benefit? Am Surg 1993;59:541–8.

    PubMed  Google Scholar 

  16. Scott-Conner CE, Hall TJ, Anglin BL, Muakkassa FF. Laparoscopic appendectomy. Ann Surg 1992;215:660–8.

    PubMed  Google Scholar 

  17. Horwitz JR, Custer MD, May BH, Mehall JR, Lally KP. Should laparoscopic appendectomy be avoided for complicated appendicitis in children? J Pediatr Surg 1997;32:1601–3.

    Article  PubMed  Google Scholar 

  18. Katkhouda N, Mason RJ, Mavor E,et al. Laparoscopic finger-assisted technique (fingeroscopy) for treatment of complicated appendicitis. J Am Coll Surg 1999;189:131–3.

    Article  PubMed  Google Scholar 

  19. Frazee RC, Roberts JW, Symmonds RE,et al. A prospective randomized trial comparing open versus laparoscopic appendectomy. Ann Surg 1994;219:725–31.

    PubMed  Google Scholar 

  20. Martin LC, Puente I, Sosa JL,et al. Open versus laparoscopic appendicectomy, a prospective randomized comparison. Ann Surg 1995;222:256–62.

    PubMed  Google Scholar 

  21. McAnena OJ, Austin O, O'Connell PR, Hedermann WP, Gorey TF, Fitzpatrick J. Laparoscopic versus open appendicectomy: a prospective evaluation. Br J Surg 1992;79:818–20.

    PubMed  Google Scholar 

  22. Mompean JA, Campos RR, Paricio PP, Aledo VS, Ayllon JG. Laparoscopic versus open appendicectomy: a prospective assessment. Br J Surg 1994;81:133–5.

    PubMed  Google Scholar 

  23. Attwood SE, Hill AD, Murphy PG, Thornton J, Stephen RB. A prospective randomized trial of laparoscopic versus open appendectomy. Surgery 1992;112:497–501.

    PubMed  Google Scholar 

  24. Chiarugi M, Buccianti P, Celona G,et al. Laparoscopic compared with open appendicectomy for acute appendicitis: a prospective study. Eur J Surg 1996;162:385–90.

    PubMed  Google Scholar 

  25. Özmen MM, Zülfikaroglu B, Tanik A, Kale IT. Laparoscopic versus open appendectomy: prospective randomized trial. Surg Laparosc Endosc 1999;9:187–9.

    Article  Google Scholar 

  26. Garbutt JM, Soper NJ, Shannon WD, Botero A, Littenberg B. Meta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy. Surg Laparosc Endosc 1999;9:17–26.

    Article  PubMed  Google Scholar 

  27. Sauerland S, Lefering R, Holthausen U, Neugebauer EA. Laparoscopic vs conventional appendectomy—a metaanalysis of randomized controlled trials. Langenbecks Arch Surg 1998;383:289–95.

    Article  PubMed  Google Scholar 

  28. Tang E, Ortega AE, Anthone GJ, Beart RW Jr. Intraabdominal abscesses following laparoscopic and open appendectomies. Surg Endosc 1996;10:327–8.

    Article  PubMed  Google Scholar 

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Author notes

  1. Christoph Wullstein M.D.

    Present address: From the Chirurgische Klinik, Knappschaftskrankenhaus Bochum-Langendreer, Universitätsklinik der Ruhr-Universität Bochum, Bochum, Germany

Authors and Affiliations

  1. the Chirurgische Abteilung, Allgemeines Krankenbaus Barmbek, Hamburg, Germany

    Sybille Barkhausen M.D. & Eberhard Gross M.D.

Authors
  1. Christoph Wullstein M.D.
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  2. Sybille Barkhausen M.D.
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  3. Eberhard Gross M.D.
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Additional information

Preliminary results of our first laparoscopically treated patients were presented in 1998 in German (Barkhausen S, Wullstein C, Gross E. Laparoskopische versus konventionelle Appendektomie—ein Vergleich hinsichtlich der frühpostoperativen Komplikationen. Zentralbl Chir 1998;123:858–62).

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Wullstein, C., Barkhausen, S. & Gross, E. Results of laparoscopicvs. conventional appendectomy in complicated appendicitis. Dis Colon Rectum 44, 1700–1705 (2001). https://doi.org/10.1007/BF02234393

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