Perforated appendicitis: is early laparoscopic appendectomy appropriate?

Laparoscopic appendectomy for nonperforated appendicitis is associated with improved outcomes; however, laparoscopy has been challenged for perforated appendicitis owing to higher morbidity compared with open or staged procedures. The purpose of this study was to determine whether the laparoscopic approach for perforated appendicitis results in improved outcomes compared with open appendectomy.

Postoperative patient records for confirmed perforated appendicitis from 2005 to 2008 were reviewed retrospectively. Demographics, surgical approach, conversion rate, and outcomes were tabulated, including length of stay (LOS), intra-abdominal and wound infections, and duration of antibiotic therapy.

The incidence of perforation was 27.9% in 885 total patients. The conversion rate from laparoscopic to open for perforated appendicitis was 16%. Hospital LOS was significantly lower in the laparoscopic group (P < .05). The incidence of postoperative abscess was not significantly different; however, the incidence of wound infection and duration of antibiotic therapy were significantly lower in the laparoscopic group (P < .05).

Successful laparoscopic appendectomy reduces LOS, antibiotic therapy, and wound infections compared with open appendectomy in perforated appendicitis without increasing the incidence of postoperative abscess. We conclude that perforated appendicitis can be managed effectively by laparoscopic appendectomy in a high percentage of patients with improved outcomes compared with open appendectomy.