Page 3 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Laparoscopic or Open Appendectomy: Which Approach is the

Best for Complicated Appendicitis?

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Ruhi F Jailani , Norjazliney A Jafri , Gerald Henry , Ismail Sagap 4
AbstrAct
Introduction: Appendicitis is more common in children and young adults. Treatment of appendicitis is either laparoscopic appendicectomy
(LA) or open appendicectomy (OA) surgery.
Aim and objective: The 30-day postoperative morbidity, surgical site infection, and reoperation rate were compared between open and
laparoscopic appendicectomies for complicated appendicitis. Secondary outcome measures were the length of hospital stay, duration of
surgery, surgical waiting time, identification of other diseases, and patient satisfaction.
Materials and methods: This retrospective study was conducted in two institutions: Hospital Selayang, Selangor, Malaysia, and HUKM, Kuala
Lumpur, Malaysia. Data were collected from January 2014 to December 2015 were reviewed.
Results: The mean age (±SD) for LA and OA were 32 (±15) and 30 (±14) years, respectively. The males showed predominance in LA and OA with
52 and 72%, respectively (p < 0.001). The majority of LA (73%) and OA (88%) were performed by the trainees (p < 0.001). There was a significant
reduction in postoperative morbidity in LA compared to OA in terms of surgical site infection, LA vs OA [n = 8 (2.7) vs 26 (6.3), p = 0.029] and
duration of surgery [LA vs OA 84 (±39) vs 68 (± 6) days (p < 0.001)]. However, for LA and OA, there were no significant differences in reoperation,
0.7 and 1.0%, respectively (p = 1.000), and length of stay in LA vs OA 3.55 (±2) vs 3.89 (±3) days, respectively (p = 0.103). Overall, patient
satisfaction scores were not found statistically significant as the response rates were only 32% in LA and 30% in OA.
Conclusion: LA significantly reduced surgical site infection and offered an advantage in the detection of other pathologies. Hence, a laparoscopic
approach should be offered to patients whose clinical diagnoses are challenging.
Keywords: Laparoscopic, Appendectomy, Complicated appendicitis.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1430

IntroductIon 1 Department of Surgery, Islamic Science University of Malaysia, Kuala
Appendicitis is more common among children and young adults. Lumpur, Malaysia
It is uncommon in the elderly where the differential diagnoses 2,3 Department of General Surgery, Hospital Selayang, Selayang,
are variable. In young patients, the perforation rate of acute Selangor, Malaysia
appendicitis is less than 20%. However, among the elderly 4 Department of Colorectal Surgery, National University of Malaysia,
patients, perforation rate accounts for about 70% or even as Cheras, Kuala Lumpur, Malaysia
high as 90%. 1 Corresponding Author: Ruhi F Jailani, Department of Surgery,
The basic surgical approach involved in the management of Islamic Science University of Malaysia, Kuala Lumpur, Malaysia, Phone:
perforated appendicitis has not undergone remarkable change +60 67985002, e-mail: ruhifadzlyana@gmail.com
over the past century. Laparoscopic appendectomy (LA) is minimally How to cite this article: Jailani RF, Jafri NA, Henry G, et al. Laparoscopic
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invasive and associated with less postoperative pain. LA has been or Open Appendectomy: Which Approach is the Best for Complicated
widely practiced for the treatment of uncomplicated appendicitis; Appendicitis? World J Lap Surg 2021; 14(1):1–4.
various reports have demonstrated its merits in assisting diagnosis, Source of support: Nil

reducing postoperative pain, and requiring an analgesic, thereby Conflict of interest: None
reducing the incidence of surgical site infection. However, the
advantages of laparoscopic surgery in the management of
complicated appendicitis, i.e., gangrenous, perforated appendicitis, appendicitis in terms of reducing surgical site infections (SSIs),
and appendicular abscess remain unclear. causing no significant additional risk of IAA. 5
Park et al. suggested that a laparoscopic approach should be We conducted a cross-sectional study in two institutions
the treatment of choice for presumed perforated appendicitis. It has for reviewing the postoperative complications of laparoscopic
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the benefit of simultaneously addressing alternative pathologies. appendectomy vs open appendectomy for complicated
Currently, the choice of operative approach depends mostly at the appendicitis. The primary objectives were detection of surgical
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surgeons’ discretion. A Cochrane study conducted by Koch et al. site infection and reoperation within 30 days postoperatively.
reported that LA increases the rate of intra-abdominal abscess (IAA) The secondary objectives were reducing the length of hospital
in adults and observed a similar trend in children. However, another stay, increasing patient satisfaction level, and identifying other
Cochrane study published in 2010 performed on adults noted diseases and postoperative complications like pneumonia, deep
that laparoscopic appendectomy is advantageous in complicated vein thrombosis, bedsores, and enterocutaneous fistulas.

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