Laparoscopic Appendectomy as a Standard of Care for Both Complicated and Uncomplicated Appendicitis in South Africa, Is It Safe? Single Center Experience

Aim: The aim of this descriptive analytical study was to describe the outcomes of using laparoscopic appendectomy (LA) as the standard of care for both complicated and uncomplicated cases of acute appendicitis in South Africa. Background: Laparoscopic appendectomy has been widely accepted as safe when performed in uncomplicated cases of acute appendicitis. However, acceptance of this procedure as the standard of care has been surrounded by controversies, with the main concern been around the safety of this procedure in complicated cases of appendicitis. Currently, there is no consensus in published literature regarding the use of LA as the standard of care in both complicated and uncomplicated appendicitis. Materials and methods: A retrospective analysis of all patients who were diagnosed with acute appendicitis at Dr George Mukhari Academic Hospital over a 3-year period was reviewed. Data were retrieved from our departmental database and analyzed using descriptive statistics. Results: A total of 746 patients were reviewed and 576 were included in the study. All these patients were offered LA. The mean age was 26.37, with 66% of our patients been males. Complicated cases formed 38% of our total study population. Laparoscopic appendectomy was performed in both complicated and uncomplicated cases of appendicitis with a success rate of 96%. Intraoperative complication rate and the relook rate was 0.5 and 7% respectively, with an overall mortality of 1.7%. Conclusion: The positive outcome found in this study when LA was used in both complicated and uncomplicated cases of acute appendicitis suggests that this approach is possible in carefully selected patients and with appropriate basic laparoscopic skills. Clinical significance: Complicated appendicitis is not a contraindication to laparoscopy.