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Evolving Surgical Approaches to Adult Perforated Appendicitis: A Systematic Narrative Review
Parin Y Patel1, Milind K Akhani2,3, Bhavin Baria4
1General Surgery, Health 1 Super Speciality Hospital, Ahmedabad, IND.
Cureus
|September 15, 2025
Summary
Laparoscopic appendectomy is preferred for perforated appendicitis, reducing complications and hospital stays compared to open surgery. Routine drainage is discouraged, with early removal favoring better outcomes.
Area of Science:
- Surgery
- Gastroenterology
- Infectious Disease
Background:
- Perforated appendicitis presents significant postoperative morbidity.
- Optimal surgical strategies for perforated appendicitis remain under investigation.
- Laparoscopic surgery and perioperative care have advanced appendicitis management.
Purpose of the Study:
- To systematically review evidence on surgical strategies for adult perforated appendicitis.
- To compare laparoscopic versus open appendectomy outcomes.
- To evaluate the impact of prophylactic drainage and surgical timing.
Main Methods:
- Systematic narrative review adhering to PRISMA 2020 guidelines.
- Inclusion of six studies with 139,269 adult patients.
- Analysis of data from January 2000 to June 2025.
Main Results:
- Laparoscopic appendectomy showed shorter hospital stays and lower complication rates versus open surgery.
- Prophylactic drainage did not reduce abscess rates and increased complications.
- Early drain removal and immediate surgery were associated with reduced morbidity and shorter hospital stays.
Conclusions:
- Laparoscopic appendectomy is the preferred approach for perforated appendicitis.
- Routine prophylactic drainage is not recommended; early drain removal is favored.
- Further multicenter randomized trials are needed to optimize perioperative care.
Keywords:
appendectomyintra abdominal abscesslaparoscopic surgeryopen surgeryperforated appendicitispostoperative complicationssurgical drainsMore Related Videos
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