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Laparoscopic Appendectomy for Complicated Appendicitis

Laparoscopic Appendectomy for Complicated Appendicitis Abstract Background: Acute gangrenous and perforating appendicitis are associated with an increased risk for postoperative complications and have been considered a relative contraindication of laparoscopic appendectomy. Objective: To determine the complication rate following laparoscopic appendectomy for gangrenous or perforating appendicitis. Design: A retrospective analysis of patients who underwent laparoscopic appendectomy for gangrenous or perforating appendicitis. Setting: A multispecialty clinic. Results: Fifteen patients underwent laparoscopic appendectomy for gangrenous appendicitis and 19 patients for perforating appendicitis. In the gangrenous appendicitis group, average operating time was 85 minutes; average length of hospitalization, 2 days; and morbidity rate, 7% (one patient with abdominal abscess). The perforating appendicitis group had an average operating time of 84 minutes, hospitalization of 7 days, and a morbidity rate of 42%. This morbidity included five patients (26%) who developed intra-abdominal abscesses, two patients (10%) in whom wound infections developed, and one patient (5%) who died of Candida sepsis and multisystem organ failure. Conclusions: Laparoscopic appendectomy can be safely performed in gangrenous appendicitis. Laparoscopic appendectomy for perforating appendicitis is associated with prolonged hospitalization and an increased risk for infectious complications.(Arch Surg. 1996;131:509-512) References 1. Semm K. Die endoscopische Appendektomie . Gynäkol Prax . 1983:7:131-140. 2. Pier A, Gotz F, Bacher C. Laparoscopic appendectomy in 625 cases: from innovation to routine . Surg Laparosc Endosc . 1991;1:8-13. 3. Scott-Conner CE, Hall TJ, Anglin BL, Maukkassa FF. Laparoscopic appendectomy: initial experience in a teaching program . Ann Surg . 1992:215:630-668.Crossref 4. Apelgren KN, Molnar RG, Kisala JM. Laparoscopic appendectomy is not better than open appendectomy . Am Surg . 1995;61:240-243. 5. Frazee RC, Roberts JW, Symmonds RE, et al. A prospective randomized trial comparing open versus laparoscopic appendectomy . Ann Surg . 1994;219:725-731.Crossref 6. Ortega AE, Hunter JG, Peters JH, et al. A prospective randomized comparison of laparoscopic appendectomy to open appendectomy . Am J Surg . 1995;169: 208-213.Crossref 7. Atwood SE, Hill AD, Murphy PG, Thorton J, Stephens RB. A prospective randomized trial of laparoscopic versus open appendectomy . Surgery . 1992;112: 497-501. 8. Lau WY, Wong SH. Randomized prospective trial of topic hydrogen peroxide in appendectomy wound infection . Am J Surg . 1981;142:393-397.Crossref 9. Meller JL, Reyes HN, Loeff DS, Federer L, Hall JR. One drug versus two drug antibiotic therapy in pediatric perforated appendicitis: a prospective randomized study . Surgery . 1991;110:764-768. 10. Lund DP, Murphy EU. Management of perforated appendicitis: a decade of aggressive treatment . J Pediatr Surg . 1994;29:1130-1134.Crossref 11. Lau WY, Teoh-Chan CH, Fan ST, Yam WC, Lau KF, Won SH. The bacteriology and septic complications of patients with appendicitis . Ann Surg . 1984:200: 576-581.Crossref 12. Schirmer BD, Schmieg RE, Dix J, et al. Laparoscopic versus traditional appendectomy for suspected appendicitis . Am J Surg . 1993;165:670-675.Crossref 13. Fritts LL, Orlando R. Laparoscopic appendectomy: a safety and cost analysis . Arch Surg . 1993;128:521-525.Crossref 14. Heinzelmann M, Simmen HP, Cummins AS, Largiader F. Is laparoscopic appendectomy the new 'gold standard'? Arch Surg . 1995;130:782-785.Crossref 15. Bonanni F, Reed J, Hartzell G, et al. Laparoscopic versus conventional appendectomy . JAm Coll Surg . 1994;179:273-278. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Laparoscopic Appendectomy for Complicated Appendicitis

Archives of Surgery , Volume 131 (5) – May 1, 1996

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1996.01430170055010
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Acute gangrenous and perforating appendicitis are associated with an increased risk for postoperative complications and have been considered a relative contraindication of laparoscopic appendectomy. Objective: To determine the complication rate following laparoscopic appendectomy for gangrenous or perforating appendicitis. Design: A retrospective analysis of patients who underwent laparoscopic appendectomy for gangrenous or perforating appendicitis. Setting: A multispecialty clinic. Results: Fifteen patients underwent laparoscopic appendectomy for gangrenous appendicitis and 19 patients for perforating appendicitis. In the gangrenous appendicitis group, average operating time was 85 minutes; average length of hospitalization, 2 days; and morbidity rate, 7% (one patient with abdominal abscess). The perforating appendicitis group had an average operating time of 84 minutes, hospitalization of 7 days, and a morbidity rate of 42%. This morbidity included five patients (26%) who developed intra-abdominal abscesses, two patients (10%) in whom wound infections developed, and one patient (5%) who died of Candida sepsis and multisystem organ failure. Conclusions: Laparoscopic appendectomy can be safely performed in gangrenous appendicitis. Laparoscopic appendectomy for perforating appendicitis is associated with prolonged hospitalization and an increased risk for infectious complications.(Arch Surg. 1996;131:509-512) References 1. Semm K. Die endoscopische Appendektomie . Gynäkol Prax . 1983:7:131-140. 2. Pier A, Gotz F, Bacher C. Laparoscopic appendectomy in 625 cases: from innovation to routine . Surg Laparosc Endosc . 1991;1:8-13. 3. Scott-Conner CE, Hall TJ, Anglin BL, Maukkassa FF. Laparoscopic appendectomy: initial experience in a teaching program . Ann Surg . 1992:215:630-668.Crossref 4. Apelgren KN, Molnar RG, Kisala JM. Laparoscopic appendectomy is not better than open appendectomy . Am Surg . 1995;61:240-243. 5. Frazee RC, Roberts JW, Symmonds RE, et al. A prospective randomized trial comparing open versus laparoscopic appendectomy . Ann Surg . 1994;219:725-731.Crossref 6. Ortega AE, Hunter JG, Peters JH, et al. A prospective randomized comparison of laparoscopic appendectomy to open appendectomy . Am J Surg . 1995;169: 208-213.Crossref 7. Atwood SE, Hill AD, Murphy PG, Thorton J, Stephens RB. A prospective randomized trial of laparoscopic versus open appendectomy . Surgery . 1992;112: 497-501. 8. Lau WY, Wong SH. Randomized prospective trial of topic hydrogen peroxide in appendectomy wound infection . Am J Surg . 1981;142:393-397.Crossref 9. Meller JL, Reyes HN, Loeff DS, Federer L, Hall JR. One drug versus two drug antibiotic therapy in pediatric perforated appendicitis: a prospective randomized study . Surgery . 1991;110:764-768. 10. Lund DP, Murphy EU. Management of perforated appendicitis: a decade of aggressive treatment . J Pediatr Surg . 1994;29:1130-1134.Crossref 11. Lau WY, Teoh-Chan CH, Fan ST, Yam WC, Lau KF, Won SH. The bacteriology and septic complications of patients with appendicitis . Ann Surg . 1984:200: 576-581.Crossref 12. Schirmer BD, Schmieg RE, Dix J, et al. Laparoscopic versus traditional appendectomy for suspected appendicitis . Am J Surg . 1993;165:670-675.Crossref 13. Fritts LL, Orlando R. Laparoscopic appendectomy: a safety and cost analysis . Arch Surg . 1993;128:521-525.Crossref 14. Heinzelmann M, Simmen HP, Cummins AS, Largiader F. Is laparoscopic appendectomy the new 'gold standard'? Arch Surg . 1995;130:782-785.Crossref 15. Bonanni F, Reed J, Hartzell G, et al. Laparoscopic versus conventional appendectomy . JAm Coll Surg . 1994;179:273-278.

Journal

Archives of SurgeryAmerican Medical Association

Published: May 1, 1996

References