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Erschienen in: Surgical Endoscopy 2/2020

28.05.2019 | Laparoscopy

Laparoscopic versus open appendectomy for perforated appendicitis in adults: randomized clinical trial

verfasst von: Ahmed Talha, Hany El-Haddad, Abd-Elhamid Ghazal, Gihan Shehata

Erschienen in: Surgical Endoscopy | Ausgabe 2/2020

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Abstract

Background

The advantages of laparoscopic appendectomy did not meet the same acceptance in the setting of perforated appendicitis as in uncomplicated appendicitis in the general surgical community. The aim of this study was to compare the clinical outcome of laparoscopic and open appendectomy in perforating appendicitis.

Methods

A randomized controlled study was conducted on 126 patients presenting with perforated appendicitis. Sixty patients were subjected to laparoscopic appendectomy (LA) and 66 patients underwent traditional open appendectomy (OA).

Results

65 (51.6%) patients were female, and 61 (48.4%) patients were male in whom the mean age was 37.6 + 8.5 years. A significant difference was calculated in the domains of postoperative pain, less need for analgesics, hospital stay, and return to daily activities. The mean operative time was shorter in OA 94 ± 10.4 min than LA 120.6 ± 17.7 min. No statistically significant difference between both groups was detected as regard occurrence of intra-abdominal collection.

Conclusion

In view of its clinical outcomes, laparoscopy should be considered in the context of perforated appendicitis. The possibility of intra-abdominal collection should not be a barrier against the widespread practice of this surgical procedure amidst laparoscopic surgeons if adequate precautions are employed.
Literatur
1.
2.
Zurück zum Zitat Petroianu AVBT (2016) Pathophysiology of acute appendicitis. JSM Gastroenterol Hepatol 4(3):1062–1066 Petroianu AVBT (2016) Pathophysiology of acute appendicitis. JSM Gastroenterol Hepatol 4(3):1062–1066
4.
Zurück zum Zitat 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):142–145PubMedCrossRef 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):142–145PubMedCrossRef
5.
Zurück zum Zitat Katkhouda N, Mason RJ, Towfigh S, Gevorgyan A, Essani R (2005) Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg 242(3):439–448PubMedPubMedCentral Katkhouda N, Mason RJ, Towfigh S, Gevorgyan A, Essani R (2005) Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg 242(3):439–448PubMedPubMedCentral
6.
Zurück zum Zitat Milewczyk M, Michalik M, Ciesielski M (2003) A prospective, randomized, unicenter study comparing laparoscopic and open treatments of acute appendicitis. Surg Endosc 17(7):1023–1028PubMedCrossRef Milewczyk M, Michalik M, Ciesielski M (2003) A prospective, randomized, unicenter study comparing laparoscopic and open treatments of acute appendicitis. Surg Endosc 17(7):1023–1028PubMedCrossRef
7.
Zurück zum Zitat Kehagias I, Karamanakos SN, Panagiotopoulos S, Panagopoulos K, Kalfarentzos F (2008) Laparoscopic versus open appendectomy: which way to go? World J Gastroenterol 14(31):4909–4914PubMedPubMedCentralCrossRef Kehagias I, Karamanakos SN, Panagiotopoulos S, Panagopoulos K, Kalfarentzos F (2008) Laparoscopic versus open appendectomy: which way to go? World J Gastroenterol 14(31):4909–4914PubMedPubMedCentralCrossRef
8.
Zurück zum Zitat Asarias JR, Schlussel AT, Cafasso DE, Carlson TL, Kasprenski MC, Washington EN et al (2011) Incidence of postoperative intraabdominal abscesses in open versus laparoscopic appendectomies. Surg Endosc 25(8):2678–2683PubMedCrossRef Asarias JR, Schlussel AT, Cafasso DE, Carlson TL, Kasprenski MC, Washington EN et al (2011) Incidence of postoperative intraabdominal abscesses in open versus laparoscopic appendectomies. Surg Endosc 25(8):2678–2683PubMedCrossRef
9.
Zurück zum Zitat 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):762–769PubMedCrossRef 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):762–769PubMedCrossRef
10.
Zurück zum Zitat 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):1705–1712PubMedCrossRef 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):1705–1712PubMedCrossRef
11.
Zurück zum Zitat 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 40:187–197PubMedCrossRef 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 40:187–197PubMedCrossRef
12.
Zurück zum Zitat Gomes CA, Sartelli M, Di Saverio S, Ansaloni L, Catena F, Coccolini F et al (2015) Acute appendicitis: proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings. World J Emerg Surg 10:60PubMedPubMedCentralCrossRef Gomes CA, Sartelli M, Di Saverio S, Ansaloni L, Catena F, Coccolini F et al (2015) Acute appendicitis: proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings. World J Emerg Surg 10:60PubMedPubMedCentralCrossRef
13.
Zurück zum Zitat Dindo D, Demartines 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(2):205–213PubMedPubMedCentralCrossRef Dindo D, Demartines 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(2):205–213PubMedPubMedCentralCrossRef
14.
Zurück zum Zitat 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):906–910PubMedCrossRef 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):906–910PubMedCrossRef
15.
Zurück zum Zitat Wullstein C, Barkhausen S, Gross E (2001) Results of laparoscopic vs. conventional appendectomy in complicated appendicitis. Dis Colon Rectum 44(11):1700–1705PubMedCrossRef Wullstein C, Barkhausen S, Gross E (2001) Results of laparoscopic vs. conventional appendectomy in complicated appendicitis. Dis Colon Rectum 44(11):1700–1705PubMedCrossRef
16.
Zurück zum Zitat 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):495–499PubMedCrossRef 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):495–499PubMedCrossRef
17.
Zurück zum Zitat 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):199–205PubMedCrossRef 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):199–205PubMedCrossRef
18.
Zurück zum Zitat Fukami Y, Hasegawa H, Sakamoto E, Komatsu S, Hiromatsu T (2007) Value of laparoscopic appendectomy in perforated appendicitis. World J Surg 31(1):93–97PubMedCrossRef Fukami Y, Hasegawa H, Sakamoto E, Komatsu S, Hiromatsu T (2007) Value of laparoscopic appendectomy in perforated appendicitis. World J Surg 31(1):93–97PubMedCrossRef
19.
Zurück zum Zitat 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):208–214PubMedCrossRef 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):208–214PubMedCrossRef
20.
Zurück zum Zitat Yau KK, Siu WT, Tang CN, Yang GP, Li MK (2007) Laparoscopic versus open appendectomy for complicated appendicitis. J Am Coll Surg 205(1):60–65PubMedCrossRef Yau KK, Siu WT, Tang CN, Yang GP, Li MK (2007) Laparoscopic versus open appendectomy for complicated appendicitis. J Am Coll Surg 205(1):60–65PubMedCrossRef
21.
Zurück zum Zitat Galli R, Banz V, Fenner H, Metzger J (2013) Laparoscopic approach in perforated appendicitis: increased incidence of surgical site infection? Surg Endosc 27(8):2928–2933PubMedCrossRef Galli R, Banz V, Fenner H, Metzger J (2013) Laparoscopic approach in perforated appendicitis: increased incidence of surgical site infection? Surg Endosc 27(8):2928–2933PubMedCrossRef
22.
Zurück zum Zitat 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):293–297PubMedPubMedCentralCrossRef 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):293–297PubMedPubMedCentralCrossRef
23.
Zurück zum Zitat Tiwari MM, Reynoso JF, Tsang AW, Oleynikov D (2011) Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis. Ann Surg 254(6):927–932PubMedCrossRef Tiwari MM, Reynoso JF, Tsang AW, Oleynikov D (2011) Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis. Ann Surg 254(6):927–932PubMedCrossRef
24.
Zurück zum Zitat 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):660–662PubMedCrossRef 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):660–662PubMedCrossRef
25.
Zurück zum Zitat Stoltzing H, Thon K (2000) Perforated appendicitis: is laparoscopic operation advisable? Dig Surg 17(6):610–616PubMedCrossRef Stoltzing H, Thon K (2000) Perforated appendicitis: is laparoscopic operation advisable? Dig Surg 17(6):610–616PubMedCrossRef
26.
Zurück zum Zitat Kirshtein B, Bayme M, Domchik S, Mizrahi S, Lantsberg L (2007) Complicated appendicitis: laparoscopic or conventional surgery? World J Surg 31(4):744–749PubMedCrossRef Kirshtein B, Bayme M, Domchik S, Mizrahi S, Lantsberg L (2007) Complicated appendicitis: laparoscopic or conventional surgery? World J Surg 31(4):744–749PubMedCrossRef
27.
Zurück zum Zitat 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):147–152PubMedCrossRef 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):147–152PubMedCrossRef
28.
Zurück zum Zitat Sauerland S, Jaschinski T, Neugebauer EA (2010) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 6(10):001546 Sauerland S, Jaschinski T, Neugebauer EA (2010) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 6(10):001546
29.
Zurück zum Zitat Ge B, Zhao H, Chen Q, Jin W, Liu L, Huang Q (2014) A randomized comparison of gasless laparoscopic appendectomy and conventional laparoscopic appendectomy. World J Emerg Surg 9(1):3PubMedPubMedCentralCrossRef Ge B, Zhao H, Chen Q, Jin W, Liu L, Huang Q (2014) A randomized comparison of gasless laparoscopic appendectomy and conventional laparoscopic appendectomy. World J Emerg Surg 9(1):3PubMedPubMedCentralCrossRef
30.
Zurück zum Zitat Garg CP, Vaidya BB, Chengalath MM (2009) Efficacy of laparoscopy in complicated appendicitis. Int J Surg 7(3):250–252PubMedCrossRef Garg CP, Vaidya BB, Chengalath MM (2009) Efficacy of laparoscopy in complicated appendicitis. Int J Surg 7(3):250–252PubMedCrossRef
31.
Zurück zum Zitat 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):2026–2040PubMedCrossRef 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):2026–2040PubMedCrossRef
32.
Zurück zum Zitat Edwards JP, Ho AL, Tee MC, Dixon E, Ball CG (2012) Wound protectors reduce surgical site infection: a meta-analysis of randomized controlled trials. Ann Surg 256(1):53–59PubMedCrossRef Edwards JP, Ho AL, Tee MC, Dixon E, Ball CG (2012) Wound protectors reduce surgical site infection: a meta-analysis of randomized controlled trials. Ann Surg 256(1):53–59PubMedCrossRef
33.
Zurück zum Zitat Evasovich MR, Clark TC, Horattas MC, Holda S, Treen L (1996) Does pneumoperitoneum during laparoscopy increase bacterial translocation? Surg Endosc 10(12):1176–1179PubMedCrossRef Evasovich MR, Clark TC, Horattas MC, Holda S, Treen L (1996) Does pneumoperitoneum during laparoscopy increase bacterial translocation? Surg Endosc 10(12):1176–1179PubMedCrossRef
34.
Zurück zum Zitat Gurtner GC, Robertson CS, Chung SC, Ling TK, Ip SM, Li AK (1995) Effect of carbon dioxide pneumoperitoneum on bacteraemia and endotoxaemia in an animal model of peritonitis. Br J Surg 82(6):844–848PubMedCrossRef Gurtner GC, Robertson CS, Chung SC, Ling TK, Ip SM, Li AK (1995) Effect of carbon dioxide pneumoperitoneum on bacteraemia and endotoxaemia in an animal model of peritonitis. Br J Surg 82(6):844–848PubMedCrossRef
35.
Zurück zum Zitat Gupta R, Sample C, Bamehriz F, Birch DW (2006) Infectious complications following laparoscopic appendectomy. Can J Surg 49(6):397–400PubMedPubMedCentral Gupta R, Sample C, Bamehriz F, Birch DW (2006) Infectious complications following laparoscopic appendectomy. Can J Surg 49(6):397–400PubMedPubMedCentral
36.
Zurück zum Zitat Reid RI, Dobbs BR, Frizelle FA (1999) Risk factors for post-appendicectomy intra-abdominal abscess. Aust N Z J Surg 69(5):373–374PubMedCrossRef Reid RI, Dobbs BR, Frizelle FA (1999) Risk factors for post-appendicectomy intra-abdominal abscess. Aust N Z J Surg 69(5):373–374PubMedCrossRef
37.
Zurück zum Zitat Moore CB, Smith RS, Herbertson R, Toevs C (2011) Does use of intraoperative irrigation with open or laparoscopic appendectomy reduce post-operative intra-abdominal abscess? Am Surg 77(1):78–80PubMed Moore CB, Smith RS, Herbertson R, Toevs C (2011) Does use of intraoperative irrigation with open or laparoscopic appendectomy reduce post-operative intra-abdominal abscess? Am Surg 77(1):78–80PubMed
38.
Zurück zum Zitat St Peter SD, Adibe OO, Iqbal CW, Fike FB, Sharp SW, Juang D et al (2012) Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis: a prospective randomized trial. Ann Surg 256(4):581–585PubMedCrossRef St Peter SD, Adibe OO, Iqbal CW, Fike FB, Sharp SW, Juang D et al (2012) Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis: a prospective randomized trial. Ann Surg 256(4):581–585PubMedCrossRef
39.
Zurück zum Zitat Tuggle KR, Ortega G, Bolorunduro OB, Oyetunji TA, Alexander R, Turner PL et al (2010) Laparoscopic versus open appendectomy in complicated appendicitis: a review of the NSQIP database. J Surg Res 163(2):225–228PubMedCrossRef Tuggle KR, Ortega G, Bolorunduro OB, Oyetunji TA, Alexander R, Turner PL et al (2010) Laparoscopic versus open appendectomy in complicated appendicitis: a review of the NSQIP database. J Surg Res 163(2):225–228PubMedCrossRef
Metadaten
Titel
Laparoscopic versus open appendectomy for perforated appendicitis in adults: randomized clinical trial
verfasst von
Ahmed Talha
Hany El-Haddad
Abd-Elhamid Ghazal
Gihan Shehata
Publikationsdatum
28.05.2019
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 2/2020
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-06847-2

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