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Surgical Endoscopy
Published in: Surgical Endoscopy 7/2019

01-07-2019 | Wound Infection | Review Article

Laparoscopic appendicectomy is superior to open surgery for complicated appendicitis

Authors: Gaik S. Quah, Guy D. Eslick, Michael R. Cox

Published in: Surgical Endoscopy | Issue 7/2019

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Abstract

Background

Over the last three decades, laparoscopic appendicectomy (LA) has become the routine treatment for uncomplicated acute appendicitis. The role of laparoscopic surgery for complicated appendicitis (gangrenous and/or perforated) remains controversial due to concerns of an increased incidence of post-operative intra-abdominal abscesses (IAA) in LA compared to open appendicectomy (OA). The aim of this study was to compare the outcomes of LA versus OA for complicated appendicitis.

Methods

A systematic literature search following PRISMA guidelines was conducted using MEDLINE, EMBASE, PubMed and Cochrane Database for randomised controlled trials (RCT) and case–control studies (CCS) that compared LA with OA for complicated appendicitis.

Results

Data from three RCT and 30 CCS on 6428 patients (OA 3,254, LA 3,174) were analysed. There was no significant difference in the rate of IAA (LA = 6.1% vs. OA = 4.6%; OR = 1.02, 95% CI = 0.71–1.47, p = 0.91). LA for complicated appendicitis has decreased overall post-operative morbidity (LA = 15.5% vs. OA = 22.7%; OR = 0.43, 95% CI: 0.31–0.59, p < 0.0001), wound infection, (LA = 4.7% vs. OA = 12.8%; OR = 0.26, 95% CI: 0.19–0.36, p < 0.001), respiratory complications (LA = 1.8% vs. OA = 6.4%; OR = 0.25, 95% CI: 0.13–0.49, p < 0.001), post-operative ileus/small bowel obstruction (LA = 3.1% vs. OA = 3.6%; OR = 0.65, 95% CI: 0.42–1.0, p = 0.048) and mortality rate (LA = 0% vs. OA = 0.4%; OR = 0.15, 95% CI: 0.04–0.61, p = 0.008). LA has a significantly shorter hospital stay (6.4 days vs. 8.9 days, p = 0.02) and earlier resumption of solid food (2.7 days vs. 3.7 days, p = 0.03).

Conclusion

These results clearly demonstrate that LA for complicated appendicitis has the same incidence of IAA but a significantly reduced morbidity, mortality and length of hospital stay compared with OA. The finding of complicated appendicitis at laparoscopy is not an indication for conversion to open surgery. LA should be the preferred treatment for patients with complicated appendicitis.
Literature
1.
Ferris M, Quan S, Kaplan BS, Molodecky N, Ball CG, Chernoff GW et al (2017) The global incidence of appendicitis: a systematic review of population-based studies. Ann Surg 266(2):237–241CrossRefPubMed
2.
3.
Masoomi H, Nguyen NT, Dolich MO, Mills S, Carmichael JC, Stamos MJ (2014) Laparoscopic appendectomy trends and outcomes in the United States: data from the Nationwide Inpatient Sample (NIS), 2004–2011. Am Surg 80(10):1074–1077PubMed
4.
Allaway MGR, Eslick GD, Kwok GTY, Cox MR (2017) The established acute surgical unit: a reduction in nighttime appendicectomy without increased morbidity. Int J Surg 43:81–85CrossRefPubMed
5.
Andersson RE (2014) Short-term complications and long-term morbidity of laparoscopic and open appendicectomy in a national cohort. Br J Surg 101(9):1135–1142CrossRefPubMed
6.
Golub R, Siddiqui F, Pohl D (1998) Laparoscopic versus open appendectomy: a metaanalysis. J Am Coll Surg 186(5):545–553CrossRefPubMed
7.
Sauerland S, Lefering R, Holthausen U, Neugebauer EA (1998) Laparoscopic vs conventional appendectomy–a meta-analysis of randomised controlled trials. Langenbecks Arch Surg 383(3–4):289–295CrossRefPubMed
8.
Wei B, Qi CL, Chen TF, Zheng ZH, Huang JL, Hu BG et al (2011) Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis. Surg Endosc 25(4):1199–1208CrossRefPubMed
9.
Ohtani H, Tamamori Y, Arimoto Y, Nishiguchi Y, Maeda K, Hirakawa K (2012) Meta-analysis of the results of randomized controlled trials that compared laparoscopic and open surgery for acute appendicitis. J Gastrointest Surg 16(10):1929–1939CrossRefPubMed
10.
Sauerland S, Jaschinski T, Neugebauer EA (2010) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 10:CD001546
11.
Gorter RR, Eker HH, Gorter-Stam MA, Abis GS, Acharya A, Ankersmit M et al (2016) Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc 30(11):4668–90CrossRefPubMedPubMedCentral
12.
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(9):2026–2040CrossRefPubMed
13.
Yu MC, Feng YJ, Wang W, Fan W, Cheng HT, Xu J (2017) Is laparoscopic appendectomy feasible for complicated appendicitis ?A systematic review and meta-analysis. Int J Surg 40:187–197CrossRefPubMed
14.
Athanasiou C, Lockwood S, Markides GA (2017) Systematic review and meta-analysis of laparoscopic versus open appendicectomy in adults with complicated appendicitis: an update of the literature. World J Surg 41(12):3083–3099CrossRefPubMed
15.
National Surgical Research C (2013) Multicentre observational study of performance variation in provision and outcome of emergency appendicectomy. Br J Surg 100(9):1240–1252CrossRef
16.
Teixeira PG, Sivrikoz E, Inaba K, Talving P, Lam L, Demetriades D (2012) Appendectomy timing: waiting until the next morning increases the risk of surgical site infections. Ann Surg 256(3):538–543CrossRefPubMed
17.
Broker ME, van Lieshout EM, van der Elst M, Stassen LP, Schepers T (2012) Discriminating between simple and perforated appendicitis. J Surg Res 176(1):79–83CrossRefPubMed
18.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535CrossRefPubMedPubMedCentral
19.
Yates F (1934) Contingency tables involving small numbers and the x2 test. J R Stat Soc 1(2):217–235
20.
Haviland MG (1990) Yates’s correction for continuity and the analysis of 2 × 2 contingency tables. Stat Med 9(4):363–367; (discussion 9–83)CrossRefPubMed
21.
22.
23.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12CrossRefPubMed
24.
25.
Schietroma M, Piccione F, Carlei F, Clementi M, Bianchi Z, de Vita F et al (2012) Peritonitis from perforated appendicitis: stress response after laparoscopic or open treatment. Am Surg 78(5):582–590PubMed
26.
Thomson JE, Kruger D, Jann-Kruger C, Kiss A, Omoshoro-Jones JA, Luvhengo T et al (2015) Laparoscopic versus open surgery for complicated appendicitis: a randomized controlled trial to prove safety. Surg Endosc 29(7):2027–2032CrossRefPubMed
27.
Taguchi Y, Komatsu S, Sakamoto E, Norimizu S, Shingu Y, Hasegawa H (2016) Laparoscopic versus open surgery for complicated appendicitis in adults: a randomized controlled trial. Surg Endosc 30(5):1705–1712CrossRefPubMed
28.
Khalili TM, Hiatt JR, Savar A, Lau C, Margulies DR (1999) Perforated appendicitis is not a contraindication to laparoscopy. Am Surg 65(10):965–967PubMed
29.
Stoltzing H, Thon K (2000) Perforated appendicitis: is laparoscopic operation advisable? Dig Surg 17(6):610–616CrossRefPubMed
30.
Piskun G, Kozik D, Rajpal S, Shaftan G, Fogler R (2001) Comparison of laparoscopic, open, and converted appendectomy for perforated appendicitis. Surg Endosc 15(7):660–662CrossRefPubMed
31.
Wullstein C, Barkhausen S, Gross E (2001) Results of laparoscopic vs. conventional appendectomy in complicated appendicitis. Dis Colon Rectum 44(11):1700–1705CrossRefPubMed
32.
So JB, Chiong EC, Chiong E, Cheah WK, Lomanto D, Goh P et al (2002) Laparoscopic appendectomy for perforated appendicitis. World J Surg 26(12):1485–1488CrossRefPubMed
33.
Kouwenhoven EA, Repelaer van Driel OJ, van Erp WF (2005) Fear for the intraabdominal abscess after laparoscopic appendectomy: not realistic. Surg Endosc 19(7):923–926CrossRefPubMed
34.
Lin HF, Wu JM, Tseng LM, Chen KH, Huang SH, Lai IR (2006) Laparoscopic versus open appendectomy for perforated appendicitis. J Gastrointest Surg 10(6):906–910CrossRefPubMed
35.
Towfigh S, Chen F, Mason R, Katkhouda N, Chan L, Berne T (2006) Laparoscopic appendectomy significantly reduces length of stay for perforated appendicitis. Surg Endosc 20(3):495–499CrossRefPubMed
36.
Pokala N, Sadhasivam S, Kiran RP, Parithivel V (2007) Complicated appendicitis–is the laparoscopic approach appropriate? A comparative study with the open approach: outcome in a community hospital setting. Am Surg 73(8):737–741; (discussion 41–2)PubMed
37.
Yau KK, Siu WT, Tang CN, Yang GP, Li MK (2007) Laparoscopic versus open appendectomy for complicated appendicitis. J Am Coll Surg 205(1):60–65CrossRefPubMed
38.
Kirshtein B, Bayme M, Domchik S, Mizrahi S, Lantsberg L (2007) Complicated appendicitis: laparoscopic or conventional surgery? World J Surg 31(4):744–749CrossRefPubMed
39.
Fukami Y, Hasegawa H, Sakamoto E, Komatsu S, Hiromatsu T (2007) Value of laparoscopic appendectomy in perforated appendicitis. World J Surg 31(1):93–97CrossRefPubMed
40.
Kehagias I, Karamanakos SN, Panagiotopoulos S, Panagopoulos K, Kalfarentzos F (2008) Laparoscopic versus open appendectomy: which way to go? World J Gastroenterol 14(31):4909–4914CrossRefPubMedPubMedCentral
41.
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(6):727–730CrossRefPubMed
42.
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(2):208–214CrossRefPubMed
43.
Garg CP, Vaidya BB, Chengalath MM (2009) Efficacy of laparoscopy in complicated appendicitis. Int J Surg 7(3):250–252CrossRefPubMed
44.
Sleem R, Fisher S, Gestring M, Cheng J, Sangosanya A, Stassen N et al (2009) Perforated appendicitis: is early laparoscopic appendectomy appropriate? Surgery 146(4):731–737; (discussion 7–8)CrossRefPubMed
45.
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(3):142–145CrossRefPubMed
46.
Lim SG, Ahn EJ, Kim SY, Chung IY, Park JM, Park SH et al (2011) A clinical comparison of laparoscopic versus open appendectomy for complicated appendicitis. J Korean Soc Coloproctol 27(6):293–297CrossRefPubMedPubMedCentral
47.
Ferranti F, Corona F, Siani LM, Stefanuto A, Aguzzi D, Santoro E (2012) Laparoscopic versus open appendectomy for the treatment of complicated appendicitis. G Chir 33(8–9):263–267PubMed
48.
Galli R, Banz V, Fenner H, Metzger J (2013) Laparoscopic approach in perforated appendicitis: increased incidence of surgical site infection? Surg Endosc 27(8):2928–2933CrossRefPubMed
49.
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(1):147–152CrossRefPubMed
50.
51.
Wilson DG, Bond AK, Ladwa N, Sajid MS, Baig MK, Sains P (2013) Intra-abdominal collections following laparoscopic versus open appendicectomy: an experience of 516 consecutive cases at a district general hospital. Surg Endosc 27(7):2351–2356CrossRefPubMed
52.
Yeom S, Kim MS, Park S, Son T, Jung YY, Lee SA et al (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(11):762–769CrossRefPubMed
53.
Quezada F, Quezada N, Mejia R, Branes A, Padilla O, Jarufe N et al (2015) Laparoscopic versus open approach in the management of appendicitis complicated exclusively with peritonitis: a single center experience. Int J Surg 13:80–83CrossRefPubMed
54.
Kim JK, Kang J, Kim WR, Park EJ, Baik SH, Lee KY (2016) Does conversion adversely impact the clinical outcomes for patients with complicated appendicitis? J Laparoendosc Adv Surg Tech A 26(8):635–640CrossRefPubMed
55.
Horvath P, Lange J, Bachmann R, Struller F, Konigsrainer A, Zdichavsky M (2017) Comparison of clinical outcome of laparoscopic versus open appendectomy for complicated appendicitis. Surg Endosc 31(1):199–205CrossRefPubMed
56.
Wu TC, Lu Q, Huang ZY, Liang XH (2017) Efficacy of emergency laparoscopic appendectomy in treating complicated appendicitis for elderly patients. Saudi Med J 38(11):1108–1112CrossRefPubMedPubMedCentral
57.
Yang J, Yu K, Li W, Si X, Zhang J, Wu W et al (2017) Laparoscopic appendectomy for complicated acute appendicitis in the elderly: a single-center experience. Surg Laparosc Endosc Percutan Tech 27(5):366–368CrossRefPubMed
58.
Cao AM, Eslick GD, Cox MR (2015) Early cholecystectomy is superior to delayed cholecystectomy for acute cholecystitis: a meta-analysis. J Gastrointest Surg 19(5):848–857CrossRefPubMed
59.
Cao AM, Eslick GD, Cox MR (2016) Early laparoscopic cholecystectomy is superior to delayed acute cholecystitis: a meta-analysis of case-control studies. Surg Endosc 30(3):1172–1182CrossRefPubMed
60.
Cao AM, Eslick GD, Nagaraja V, Ma D, Cox MR (2016) Early laparoscopic cholecystectomy is superior to delayed acute cholecystitis: a meta-analysis of case-control studies. Surg Endosc 30(3):1183CrossRefPubMed
61.
62.
Bickell NA, Aufses AH Jr, Rojas M, Bodian C (2006) How time affects the risk of rupture in appendicitis. J Am Coll Surg 202(3):401–406CrossRefPubMed
63.
64.
Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA (2014) Meta-analysis of laparoscopic vs open cholecystectomy in elderly patients. World J Gastroenterol 20(46):17626–17634CrossRefPubMedPubMedCentral
65.
Coccolini F, Catena F, Pisano M, Gheza F, Fagiuoli S, Di Saverio S et al (2015) Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. Int J Surg 18:196–204CrossRefPubMed
66.
Rondelli F, Trastulli S, Avenia N, Schillaci G, Cirocchi R, Gulla N et al (2012) Is laparoscopic right colectomy more effective than open resection? A meta-analysis of randomized and nonrandomized studies. Colorectal Dis 14(8):e447–e469CrossRefPubMed
67.
Lorenzon L, La Torre M, Ziparo V, Montebelli F, Mercantini P, Balducci G et al (2014) Evidence based medicine and surgical approaches for colon cancer: evidences, benefits and limitations of the laparoscopic vs open resection. World J Gastroenterol 20(13):3680–3692CrossRefPubMedPubMedCentral
68.
Bregendahl S, Norgaard M, Laurberg S, Jepsen P (2013) Risk of complications and 30-day mortality after laparoscopic and open appendectomy in a Danish region, 1998–2007; a population-based study of 18,426 patients. Pol Przegl Chir 85(7):395–400CrossRefPubMed
69.
Wysocki AP, Allen J, Rey-Conde T, North JB (2015) Mortality from acute appendicitis is associated with complex disease and co-morbidity. ANZ J Surg 85(7–8):521–524CrossRefPubMed
70.
Andersson MN, Andersson RE (2011) Causes of short-term mortality after appendectomy: a population-based case-controlled study. Ann Surg 254(1):103–107CrossRefPubMed
71.
Reid RI, Dobbs BR, Frizelle FA (1999) Risk factors for post-appendicectomy intra-abdominal abscess. Aust N Z J Surg 69(5):373–374CrossRefPubMed
72.
Schlottmann F, Sadava EE, Pena ME, Rotholtz NA (2017) Laparoscopic appendectomy: risk factors for postoperative intraabdominal abscess. World J Surg 41(5):1254–1258CrossRefPubMed
73.
Navez B, Tassetti V, Scohy JJ, Mutter D, Guiot P, Evrard S et al (1998) Laparoscopic management of acute peritonitis. Br J Surg 85(1):32–36CrossRefPubMed
74.
Navez B, Delgadillo X, Cambier E, Richir C, Guiot P (2001) Laparoscopic approach for acute appendicular peritonitis: efficacy and safety: a report of 96 consecutive cases. Surg Laparosc Endosc Percutan Tech 11(5):313–316CrossRefPubMed
75.
Cheng Y, Xiong XZ, Wu SJ, Lin YX, Cheng NS (2012) Laparoscopic vs. open cholecystectomy for cirrhotic patients: a systematic review and meta-analysis. Hepatogastroenterology 59(118):1727–1734PubMed
76.
Cirocchi R, Farinella E, Trastulli S, Sciannameo F, Audisio RA (2012) Elective sigmoid colectomy for diverticular disease. Laparoscopic vs open surgery: a systematic review. Colorectal Dis 14(6):671–683CrossRefPubMed
77.
Suh YJ, Jeong SY, Park KJ, Park JG, Kang SB, Kim DW et al (2012) Comparison of surgical-site infection between open and laparoscopic appendectomy. J Korean Surg Soc 82(1):35–39CrossRefPubMed
78.
Richards C, Edwards J, Culver D, Emori TG, Tolson J, Gaynes R et al (2003) Does using a laparoscopic approach to cholecystectomy decrease the risk of surgical site infection? Ann Surg 237(3):358–362PubMedPubMedCentral
79.
Redmond HP, Watson RW, Houghton T, Condron C, Watson RG, Bouchier-Hayes D (1994) Immune function in patients undergoing open vs laparoscopic cholecystectomy. Arch Surg 129(12):1240–1246CrossRefPubMed
80.
Cox MR, Gunn IF, Eastman MC, Hunt RF, Heinz AW (1992) Open cholecystectomy: a control group for comparison with laparoscopic cholecystectomy. Aust N Z J Surg 62(10):795–801CrossRefPubMed
81.
Ephgrave KS, Kleiman-Wexler R, Pfaller M, Booth B, Werkmeister L, Young S (1993) Postoperative pneumonia: a prospective study of risk factors and morbidity. Surgery 114(4):815–819; (discussion 9–21)PubMed
82.
Lee C-Z, Kao L-T, Lin H-C, Wei P-L (2015) Comparison of clinical outcome between laparoscopic and open right hemicolectomy: a nationwide study. World J Surg Oncol 13:250CrossRefPubMedPubMedCentral
83.
Lee CZ, Kao LT, Lin HC, Wei PL (2015) Comparison of clinical outcome between laparoscopic and open right hemicolectomy: a nationwide study. World J Surg Oncol 13:250CrossRefPubMedPubMedCentral
84.
Garcia-Caballero M, Vara-Thorbeck C (1993) The evolution of postoperative ileus after laparoscopic cholecystectomy. A comparative study with conventional cholecystectomy and sympathetic blockade treatment. Surg Endosc 7(5):416–419CrossRefPubMed
85.
Schwenk W, Bohm B, Haase O, Junghans T, Muller JM (1998) Laparoscopic versus conventional colorectal resection: a prospective randomised study of postoperative ileus and early postoperative feeding. Langenbecks Arch Surg 383(1):49–55CrossRefPubMed
86.
Alverdy J, Chi HS, Sheldon GF (1985) The effect of parenteral nutrition on gastrointestinal immunity. The importance of enteral stimulation. Ann Surg 202(6):681–684CrossRefPubMedPubMedCentral
87.
Allaway M, Clement k Eslick GD, Cox MR (2018) Early laparoscopic washout may resolve persistent intra-abdominal infection post appendicectomy. World J Surg 43:998CrossRef
Metadata
Title
Laparoscopic appendicectomy is superior to open surgery for complicated appendicitis
Authors
Gaik S. Quah
Guy D. Eslick
Michael R. Cox
Publication date
01-07-2019
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 7/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-06746-6

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