The efficiency of laparoscopy in patients with complicated appendicitis

Aim: Laparoscopic approach for complicated appendicitis (CA) is a controversial issue. Although it has been generally recommended, conflicting results have been reported in literature. The aim of this study is to obtain the current results regarding laparoscopic surgery for CA. Material and Methods: Patients who underwent surgery for acute appendicitis between July 2009 and January 2011 in Dr Sadi Konuk Training and Research Hospital were retrospectively analyzed. Appendicitis was considered as CA when there were one of the following criteria; existence of accompanying intra-abdominal abscess, peritonitis, gangrene or perforation confirmed by a histopathological examination. The patients with CA were divided into two groups, laparoscopic appendectomy (LA) group and open appendectomy (OA) group. Demographics, perioperative findings and postoperative course were compared. Results: 846 patients with the diagnosis of appendicitis underwent surgery at our center. Of these, 124 cases were complicated appendicitis. Eighty-five (68.5%) and 39 (31.5%) patients underwent to LA and OA, respectively. The mean ages in two groups were compatible (p=0.224). The mean body mass index was significantly higher in LA group. Presence of accompanying abscess and use of intra-abdominal drain were similar in both groups (p>0.05). Duration of operation was significantly higher in LA group (76.133.7 vs 57.8 22.5) (p=0.001). Although postoperative intra-abdominal abscess formation was slightly higher in LA groups (7 cases vs 1 case), there was no difference in postoperative complication between two groups. Length of hospitalization was also not different in both groups. Time to oral feeding was significantly earlier in LA group. Conclusion: Laparoscopy in complicated appendicitis can be the first choice with no increase in postoperative complications. However, the longer operation time is still a problem for laparoscopic technique despite increasing experience. According to us, future studies should be focused on this problem.