Is Laparoscopic Appendectomy Appropriate Treatment For Perforated Acute Appendicitis With Peritonitis? Volume 4 - Issue 2

Jurij Janež*

• Department Of Abdominal Surgery, University Medical Centre Ljubljana, Slovenia

Received: April 24, 2018;   Published: May 02, 2018

*Corresponding author: Jurij Janež, Department Of Abdominal Surgery, University Medical Centre Ljubljana, Zaloska Cesta 7, 1525 Ljubljana, Slovenia, Europe

DOI: 10.26717/BJSTR.2018.04.001024

Abstract PDF

Acute appendicitis is a common cause of acute abdominal pain and is one of the most common abdominal surgical emergencies. In the past, the treatment of acute appendicitis consisted of open appendectomy through a small skin incision in the right lower abdominal quadrant. In some cases of perforated appendic it is with diffuse peritonitis, median laparoto my wasper formed with appendectomy, irrigation and drainage of the abdominal cavity. Now a days, surgical treatment of acute appendicits has shifted from open appendectomy to laparoscopic appendectomy in adults and in pediatricpatients [1].

With the development of minimally invasive surgery, the treatment of acute appendicitis has shifted from open appendectomy to laparoscopic appendectomy. Laparoscopic appendectomy has some benefits, such as less wound pain, less wound infection, a shorter hospital stay, and faster recovery. At the beginning, the laparoscopic approach has been advocated only in cases of uncomplicated appendicitis, but in recent years laparoscopic approach has been used also in cases of perforated appendicitis [2]. Several studies have been performed to evaluate the feasibility of a laparoscopic approach in adults and in children with generalized peritonitis secondary to perforated appendicitis and they concluded, that laparoscopic appendectomy is feasible for use both in children and in adults with generalized peritonitis from perforated appendicitis. The rates of conversions and peri operative complication rates were comparable in both groups. Galli et al. [3,4] concluded from their retrospective analysis, that laparoscopic appendectomy results in a significantly shorter hospital stay, fewer overall postoperative complications, and fewer wound infections compared to open appendectomy. Infectious complication rates were similar for both procedures. Laparoscopic appendectomy provides a safe option for treating patients with perforated appendicitis. Ferranti et al. [5] observed in their retrospective analysis higher incidence of postoperative intraabdominal abscesses (16,6%), although not statistically significant, in patients after laparoscopic appendectomy compared with open appendectomy group (5%). On the other hand the rate of wound infection was lower (5%) after laparoscopic appendectomy versus open appendectomy (20%). They recommended, that laparoscopic appendectomy should be utilised with caution in cases of perforated appendicitis, because it is associated with an increased risk of postoperative intra-abdominal abscesses compared with open appendectomy [6]. According to WSES (World Society of Emergency Surgery) guidelines from year 2016, the complicated appendicitis can be approached laparoscopically by experienced surgeon. It has several advantages, such as lower overall complications, read missionrate, small bowel obstruction, infectious complications and faster recovery. Laparoscopic appendectomy for complicated appendicits can be performed with low cost equipment, allowing significantly lower overall costs compared to open appendectomy [1].

Complicated acute appendicitis was once a contraindication for laparoscopic appendectomy. Today laparoscopic appendectomy is the first choice of surgical treatment for most of the surgeon seven in cases of complicated appendicitis, as it turned out to be a safe and effective treatment modalitiy.

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3. Chang HK, Han SJ, Choi SH, Oh JT (2013) Feasibility of a laparoscopic approach for generalized peritonitis from perforated appendicitis in children. Yonsei Med J 54(6): 1478-1483.
4. Park HC, Kim BS, Lee BH (2011) Laparoscopic treatment of presumed 6. Ferranti F, Corona F, Siani LM, Stefanuto A, Aguzzi D, et al. (2012) perforated appendicitis in consecutive patients. Surg Laparosc Endosc Laparoscopic versus open appendec to my for the treatment of Percutan Tech 21(4): 278-281. complicated appendicitis. G Chir 33(8-9): 263-267.
5. Galli R, Banz V, Fenner H, Metzger J (2013) Laparoscopic approach in perforated appendicitis: increased incidence of surgical site infection?
6. Ferranti F, Corona F, Siani LM, Stefanuto A, Aguzzi D, et al. (2012) perforated appendicitis in consecutive patients. Surg Laparosc Endosc Laparoscopic versus open appendec to my for the treatment of Percutan Tech 21(4): 278-281. complicated appendicitis. G Chir 33(8-9): 263-267.