Abstract
Background
The aim of this study was to assess whether laparoscopic appendectomy (LA) for complicated appendicitis (CA) effectively reduces the incidence of postoperative complications and improves various measurements of postoperative recovery in adults compared with open appendectomy (OA).
Methods
This single-center, randomized controlled trial was performed in the Nagoya Daini Red Cross Hospital. Patients diagnosed as having CA with peritonitis or abscess formation were eligible to participate and were randomly assigned to an LA group or an OA group. The primary study outcome was development of infectious complications, especially surgical site infection (SSI), within 30 days of surgery.
Results
Between October 2008 and August 2014, 81 patients were enrolled and randomly assigned with a 1:1 allocation ratio (42, LA; 39, OA). All were eligible for study of the primary endpoint. Groups were well balanced in terms of patient characteristics and preoperative levels of C-reactive protein. SSI occurred in 14 LA group patients (33.3 %) and in 10 OA group patients (25.6 %) (OR 1.450, 95 % CI 0.553–3.800; p = 0.476). Overall, the rate of postoperative complications, including incisional or organ/space SSI and stump leakage, did not differ significantly between groups. No significant differences between groups were found in hospital stay, duration of drainage, analgesic use, or parameters for postoperative recovery except days to walking.
Conclusion
These results suggested that LA for CA is safe and feasible, while the distinguishing benefit of LA was not validated in this clinical trial.
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References
Asarias JR, Schlussel AT, Cafasso DE, Carlson TL, Kasprenski MC, Washington EN, Lustik MB, Yamamura MS, Matayoshi EZ, Zagorski SM (2011) Incidence of postoperative intraabdominal abscesses in open versus laparoscopic appendectomies. Surg Endosc 25:2678–2683
Lin HF, Lai HS, Lai IR (2014) Laparoscopic treatment of perforated appendicitis. World J Gastroenterol 21(20):14338–14347
Markides G, Subar D, Riyad K (2010) Laparoscopic versus open appendectomy in adults with complicated appendicitis: systematic review and meta-analysis. World J Surg 34:2026–2040
Tiwari MM, Reynoso JF, Tsang AW, Oleynikov D (2011) Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis. Ann Surg 254:927–932
Tuggle KR, Ortega G, Bolorunduro OB, Oyetunji TA, Alexander R, Turner PL, Chang DC, Cornwell EE 3rd, Fullum TM (2010) Laparoscopic versus open appendectomy in complicated appendicitis: a review of the NSQIP database. J Surg Res 163:225–228
Vahdad MR, Troebs RB, Nissen M, Burkhardt LB, Hardwig S, Cernaianu G (2013) Laparoscopic appendectomy for perforated appendicitis in children has complication rates comparable with those of open appendectomy. J Pediatr Surg 48:555–561
Dimitriou I, Reckmann B, Nephuth O, Betzler M (2013) Single institution’s experience in laparoscopic appendectomy as a suitable therapy for complicated appendicitis. Langenbecks Arch Surg 398:147–152
Galli R, Banz V, Fenner H, Metzger J (2013) Laparoscopic approach in perforated appendicitis: increased incidence of surgical site infection? Surg Endosc 27:2928–2933
Katsuno G, Nagakari K, Yoshikawa S, Sugiyama K, Fukunaga M (2009) Laparoscopic appendectomy for complicated appendicitis: a comparison with open appendectomy. World J Surg 33:208–214
Khiria LS, Ardhnari R, Mohan N, Kumar P, Nambiar R (2011) Laparoscopic appendicectomy for complicated appendicitis: is it safe and justified?: a retrospective analysis. Surg Laparosc Endosc Percutan Tech 21:142–145
Lim SG, Ahn EJ, Kim SY, Chung IY, Park JM, Park SH, Choi KW (2011) A clinical comparison of laparoscopic versus open appendectomy for complicated appendicitis. J Korean Soc Coloproctol 27:293–297
Malagon AM, Arteaga-Gonzalez I, Rodriguez-Ballester L (2009) Outcomes after laparoscopic treatment of complicated versus uncomplicated acute appendicitis: a prospective, comparative trial. J Laparoendosc Adv Surg Tech A 19:721–725
Park HC, Yang DH, Lee BH (2009) The laparoscopic approach for perforated appendicitis, including cases complicated by abscess formation. J Laparoendosc Adv Surg Tech A 19:727–730
Thereaux J, Veyrie N, Corigliano N, Servajean S, Czernichow S, Bouillot JL (2014) Is laparoscopy a safe approach for diffuse appendicular peritonitis? Feasibility and determination of risk factors for post-operative intra-abdominal abscess. Surg Endosc 28:1908–1913
Yeom S, Kim MS, Park S, Son T, Jung YY, Lee SA, Chang YS, Kim DH, Han JK (2014) Comparison of the outcomes of laparoscopic and open approaches in the treatment of periappendiceal abscess diagnosed by radiologic investigation. J Laparoendosc Adv Surg Tech A 24:762–769
Thomson JE, Kruger D, Jann-Kruger C, Kiss A, Omoshoro-Jones JA, Luvhengo T, Brand M (2015) Laparoscopic versus open surgery for complicated appendicitis: a randomized controlled trial to prove safety. Surg Endosc 29:2027–2032
Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 20:271–274
Fukami Y, Hasegawa H, Sakamoto E, Komatsu S, Hiromatsu T (2007) Value of laparoscopic appendectomy in perforated appendicitis. World J Surg 31:93–97
Edwards JP, Ho AL, Tee MC, Dixon E, Ball CG (2012) Wound protectors reduce surgical site infection: a meta-analysis of randomized controlled trials. Ann Surg 256:53–59
Lee P, Waxman K, Taylor B, Yim S (2009) Use of wound-protection system and postoperative wound-infection rates in open appendectomy: a randomized prospective trial. Arch Surg 144:872–875
Li X, Zhang J, Sang L, Zhang W, Chu Z, Li X, Liu Y (2010) Laparoscopic versus conventional appendectomy—a meta-analysis of randomized controlled trials. BMC Gastroenterol 10:129
Allemann P, Probst H, Demartines N, Schafer M (2011) Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis–the role of routine abdominal drainage. Langenbecks Arch Surg 396:63–68
Moore CB, Smith RS, Herbertson R, Toevs C (2011) Does use of intraoperative irrigation with open or laparoscopic appendectomy reduce post-operative intra-abdominal abscess? Am Surg 77:78–80
Ohno Y, Furui J, Kanematsu T (2004) Treatment strategy when using intraoperative peritoneal lavage for perforated appendicitis in children: a preliminary report. Pediatr Surg Int 20:534–537
Pakula AM, Skinner R, Jones A, Chung R, Martin M (2014) Role of drains in laparoscopic appendectomy for complicated appendicitis at a busy county hospital. Am Surg 80:1078–1081
St Peter SD, Adibe OO, Iqbal CW, Fike FB, Sharp SW, Juang D, Lanning D, Murphy JP, Andrews WS, Sharp RJ, Snyder CL, Holcomb GW, Ostlie DJ (2012) Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis: a prospective randomized trial. Ann Surg 256:581–585
Andersson RE, Petzold MG (2007) Nonsurgical treatment of appendiceal abscess or phlegmon: a systematic review and meta-analysis. Ann Surg 246:741–748
Nazarey PP, Stylianos S, Velis E, Triana J, Diana-Zerpa J, Pasaron R, Stylianos V, Malvezzi L, Knight C, Burnweit C (2014) Treatment of suspected acute perforated appendicitis with antibiotics and interval appendectomy. J Pediatr Surg 49:447–450
Simillis C, Symeonides P, Shorthouse AJ, Tekkis PP (2010) A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon). Surgery 147:818–829
Williams RF, Interiano RB, Paton E, Eubanks JW, Huang EY, Langham MR, Blakely ML (2014) Impact of a randomized clinical trial on children with perforated appendicitis. Surgery 156:462–466
Beldi G, Vorburger SA, Bruegger LE, Kocher T, Inderbitzin D, Candinas D (2006) Analysis of stapling versus endoloops in appendiceal stump closure. Br J Surg 93:1390–1393
Kazemier G, in’t Hof KH, Saad S, Bonjer HJ, Sauerland S (2006) Securing the appendiceal stump in laparoscopic appendectomy: evidence for routine stapling? Surg Endosc 20:1473–1476
Sahm M, Kube R, Schmidt S, Ritter C, Pross M, Lippert H (2011) Current analysis of endoloops in appendiceal stump closure. Surg Endosc 25:124–129
Duepree HJ, Senagore AJ, Delaney CP, Fazio VW (2003) Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy. J Am Coll Surg 197:177–181
Laurent C, Leblanc F, Bretagnol F, Capdepont M, Rullier E (2008) Long-term wound advantages of the laparoscopic approach in rectal cancer. Br J Surg 95:903–908
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Yoshiro Taguchi, Shunichiro Komatsu, Eiji Sakamoto, Shinji Norimizu, Yuji Shingu, and Hiroshi Hasegawa have no conflict of interest.
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Taguchi, Y., Komatsu, S., Sakamoto, E. et al. Laparoscopic versus open surgery for complicated appendicitis in adults: a randomized controlled trial. Surg Endosc 30, 1705–1712 (2016). https://doi.org/10.1007/s00464-015-4453-x
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DOI: https://doi.org/10.1007/s00464-015-4453-x