Laparoscopic Management of Complicated Appendicitis

BACKGROUND Complicated appendicitis is associated with a significant risk of postoperative morbidity, making the value of the minimally invasive approach controversial. METHODS From January 2000 to October 2004, 42 patients with complicated appendicitis were categorized into 3 groups: Group 1--perforation, Group 2-abscess formation, and Group 3--generalized peritonitis. The conversion rate, the operative time, the mean hospital stay, the postoperative abdominal and wound infections, the return to oral intake, and the late obstructive complications were analyzed in relation to clinicopathological subgroupings. RESULTS Conversion was needed in 2 patients (4.8%) due to adenocarcinoma (Group 2) and technical difficulties (Group 1). Mean operative time was 67 minutes (range, 48 to 88), and mean hospital stay was 3.2 days (range, 2 to 5). No postoperative wound infection or intraabdominal abscess was encountered. A clear liquid diet was instituted at the first postoperative 24 hours, and the mean time of flatus passage was 26.5 hours (range, 19 to 31). No statistically significant differences in operative time (P=0.13) and flatus passage (P=0.18) were found among the 3 groups. Two cases of late intestinal obstruction were treated successfully with conservative measures. CONCLUSIONS Laparoscopic appendectomy is a safe, feasible treatment option in complicated appendicitis. It is not associated with increased risk of septic postoperative complications including wound infections and intraabdominal abscess formation.