Laparoscopic versus open appendectomy: the risk of postoperative infectious complications

Despite the reported advantages of laparoscopic appendectomy (LA), ongoing debate exists about a possible increase in postoperative infectious complication rates especially intraabdominal infections and wound infection, unless wound protection is utilized.

All consecutive appendectomies (open and laparoscopic) performed over 4 months were included in this prospective study. Demographic details, operative time, time to conversion, infective postoperative complications, and delay in discharge were recorded. The patients were divided into 2 groups, laparoscopic (LA) and open appendectomy (OA).

A total of 134 appendectomies were performed, 80 in the LA group and 54 in the OA group. Twenty-six (19.4%) appendices were perforated at the time of operation. The median patient age was 24 years (range, 7 to 63). Patients included 71 females and 63 males. Operating time in the LA group was longer with a median duration of 51.3 minutes (range, 35 to 100) compared with 40.6 minutes (range, 30 to 95) in the OA group. An extraction bag was used in 59/71 (83%) LA patients. Wound infection was recorded in 6 patients (5/54 in OA and 1/80 in LA). The site of wound infection was the port of specimen extraction in the laparoscopic group, and an extraction bag was not used. Wound infection delayed hospital discharge by an average of 2 days. Intraabdominal abscess formation complicated the outcome in 2 patients (1 in the LA group and 1 in the OA group).

Wound infection is less common in LA than in OA, and an extraction bag is recommended. Intraabdominal infection rates do not appear to be increased, though the numbers in this study are relatively small. The longer operating time is minimal given the better results, and LA is the optimal approach to the diagnosis and management of acute appendicitis.