MIAMI BEACH — Laparoscopic management of acute appendicitis decreases recovery time and wound infection rates while showing the same efficacy as the open technique, reported Dalibor Panuska, M.D., at a congress on laparoscopy and minimally invasive surgery.
Although an increasing number of studies have shown the benefits of laparoscopic appendectomy in general, the advantages of the technique specifically for acute appendicitis are not yet been clearly established, reported Dr. Panuska from District Hospital Zvolen, in Slovakia.
In a retrospective study of 553 patients with acute appendicitis who were operated on using either laparoscopy (315) or open surgery (238), the laparoscopic technique resulted in shorter hospital stays (4.4 vs. 5.2 days), fewer doses of postoperative opioids (1.36 vs. 2. 56), and earlier resumption of peristalsis (19 vs. 28 hours), he said at the congress, which was sponsored by the Society of Laparoendoscopic Surgeons.
There was a 6% conversion rate from laparoscopy to open technique. The reasons for conversion were technical failure, perforated appendix, general peritonitis, cavum Douglasi abscesses, and gangrenous or phlegmonous appendix, Dr. Panuska reported.
Wound infections were considerably fewer in the laparoscopy group (1.6% vs. 7.5%). Late abdominal obstruction, a recognized complication of the open technique, was completely absent in the laparoscopic group but occurred in 0.3% of the open-surgery group.
Dr. Panuska said the most important reason for performing the procedure laparoscopically is the opportunity that it affords to pick up other pelvic—particularly gynecologic—pathologies.
“Laparoscopic appendectomy is safe and feasible even in severe, advanced, or destructive forms of acute appendicitis,” he concluded.