Top

International Journal of Colorectal Disease

Published in:

01-03-2015 | Original Article

Laparoscopic versus open appendectomy for complicated appendicitis in high risk patients

Authors: G. Werkgartner, H. Cerwenka, A. El Shabrawi, H. Bacher, H. Hauser, H. J. Mischinger, M. Wagner, D. Wagner

Published in: International Journal of Colorectal Disease | Issue 3/2015

Abstract

Introduction

Laparoscopic appendectomy is widely used for the treatment of complicated appendicitis. Its use in patients with high operative risk is still on debate. The aim of the presented study was to investigate the benefits of laparoscopic appendectomy in patients with high peri- and postoperative risk factors.

Methods

We performed a retrospective analysis of all patients who underwent appendectomy in our center between 2006 and 2013. Patients were classified according to their preoperative risk (classification of the American Society of Anesthesia—ASA score). Only patients with ASA 3 and 4 were included and were divided into two groups—open appendectomy (OA group) and laparoscopic appendectomy (LA group).

Results

The operation time was slightly longer in the LA group (p = 0.05), but hospital stay was shorter (p = 0.05). Complications graded according to the Clavien Dindo classification were slightly more frequent in patients after LA, whereas severe complications occurred more frequently in patients after OA (p = 0.01). The postoperative WBC decreased steadily and significantly in patients after OA, whereas the decrease in patients after LA was delayed (p = 0.03). CRP slightly increased after OA and decreased thereafter, whereas it steadily decreased after LA (p = 0.05).

Conclusion

Laparoscopic appendectomy can be recommended for patients with complicated appendicitis even with higher risk categories.

Stewart B, Khanduri P, McCord C, Ohene-Yeboah M, Uranues S, Vega Rivera F, Mock C (2014) Global disease burden of conditions requiring emergency surgery. BJS 101:e9–e22CrossRef

Minutolo V, Licciaredello A, Di Stefano B, Arena M, Arena G, Antonacci V. Outcomes and cost analysis of laparoscopic versus open appendectomy for treatment of acute appendicitis: 4 years experience in a district hospital. BMC Surgery 2014 epub ahead of print

Tannoury J, Abbound B (2013) Treatment options of inflammatory appendiceal masses in adults. Wold J Gastroenterol 19(25):3942–3950

Mutter D, Marescaux J (2013) Appendicitis/Diverticutlitis: Minimally invasive surgery. Dig Dis 31:76–82CrossRefPubMed

Markides G, Subar D, Riyad K (2010) Laparoscopic versus open appendectomy in adults with complicated appendicitis: systematic review and meta-analysis. World J Surg 34:2026–2040CrossRefPubMed

Milewczyk M, Michalik M, Ciesielski M (2003) A porspective, randomized, unicenter study comparing laparoscopic and open treatment of acute appendicitis. Surg Endosc 17:1023–1028CrossRefPubMed

Nakhamiyayev V, Galldin L, Chiarello M, Lumba A, Gorecki PJ. Laparoscopic appendectomy is the preffered approach for appendicitis: a retrospective review of two practice patterns. Surg Endosc 2ß1ß;24: 859–864

Graff L, Russel J, Seashore J, Tate J, Elwell A, Prete M (2000) Flase negative and false positive errors in abdominal pain evaluation: Failure to diagnose acute appendicitis and unnecessary surgery. Acad Emerg Med 7:1244–1255CrossRefPubMed

Flum DR, Morris A, Koepsell T, Dellinger EP (2001) Has misdiagnosis of appendicitis decreased over time? A population based analysis. JAMA 286:1748–1753CrossRefPubMed

10.

Flum DR, Koepsell T (2002) The clinical and economic correlates of misdiagnosed appendicitis: Nationwide analysis. Arch Surg 137:799–804CrossRefPubMed

11.

Sack U, Biereder B, Elouahidi T, Bauer K, Keller T, Trobs RB (2006) Diagnostic value of blood inflammatory markers for detection of acute appendicitis in children. BMC Surg 6:15CrossRefPubMedCentralPubMed

12.

Yu CW, Juan LI, Wu MH, Shen CJ, Wu JY, Lee CC (2013) Systematic review and meta analysis of the diagnostic accuracy of procalcitonin, C reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg 100:322–329CrossRefPubMed

13.

Dindo D, de Martines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–30CrossRefPubMedCentralPubMed

14.

Varela JE, Hinojosa MW, Nguyen NT (2008) Laparoscopy should be the approach of choice for acute appendicitis in morbidly obese. Am J Surg 196:218–222CrossRefPubMed

15.

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 10:129CrossRefPubMedCentralPubMed

16.

Krisher SL, Browne A, Dibbins A, Tkacz N, Curci M (2001) Intra abdominal abscess after laparoscopic appendectomy for perforated appendicitis. Arch Surg 136:438–441CrossRefPubMed

17.

Cueto J, D’Allemagne B, Váuqueu-Frias JA, Gomez S, Delgado F, Trullenque L, Fajardo R, Valencia S, Poggi L, Ballí J, Diaz J, González R, Mansur JH, Franklin ME (2006) Morbidity of laparoscopic surgery for complicated appendicitis: an international study. Surg Endosc 20:717–720CrossRefPubMed

18.

Gupta R, Samle C, Bamehriz F, Birch DW (2006) Infectious complications following laparoscopic appendectomy. Can J Surg 49:397–400PubMedCentralPubMed

19.

Wei HB, Huang JL, Zheng ZH, Wei B, Zheng F, Qiu WS, Guo WP, Chen TF, Wang TB (2010) Laparoscopic verus open appendectomy: a prospective randomized comparison. Surg Endosc 24:266–269CrossRefPubMed

20.

Sauerland S, Lefereing R, Neugebauer E (2004) Laparoscopic versus open surgery for suspected appendicitis (review). Cochrane Database Syst Rev 4, DS001546

21.

Sauerland S, Lefering R, Neugebauer EA (2010) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 10, CD001546PubMed

22.

Mischinger HJ, Berger A, Colombo T, Kornberger L (1989) Is the search for Meckels diverticulum still a current problem in common surgical practice? Chirurg 60:549–552

23.

McGrath B, Buckius MT, Grim R, Bell T, Ahuja V (2011) Economics of appendicitis: cost trend analysis of laparoscopic versus open appendectomy from 1998 to 2008. J Surg Res 171:e161–168CrossRefPubMed

Title: Laparoscopic versus open appendectomy for complicated appendicitis in high risk patients
Authors: G. Werkgartner
H. Cerwenka
A. El Shabrawi
H. Bacher
H. Hauser
H. J. Mischinger
M. Wagner
D. Wagner
Publication date: 01-03-2015
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 3/2015
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-014-2095-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Laparoscopic versus open appendectomy for complicated appendicitis in high risk patients

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2015

A minimum yield of twelve lymph nodes in rectal cancer remains valid in the era of neo-adjuvant treatment

Staged seton fistulotomy after restorative proctocolectomy with ileal pouch–anal anastomosis accompanied by a decline in anal pressure during manometry

Radiation therapy in patients with inflammatory bowel disease and colorectal cancer: Risks and benefits

Long-term results after endoanal advancement flap repair for fistulas-in-ano. How important is the aetiology?

Risk factors for colorectal neoplasms based on colonoscopy and pathological diagnoses of Chinese citizens: a multicenter, case-control study

Cecal recurrence after one-stage resection of obstructive rectal cancer with intraoperative colonic lavage through the appendix: a curious coincidence