Laparoscopicvs open appendectomy in the management of appendicitis complicated by generalized peritonitis: a prospective randomized trial

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Abstract

Background
Laparoscopic appendectomy (LA) is performed worldwide in the treatment of acute appendicitis (AP), even if complicated by localized peritonitis. However, the role of the LA in the treatment of AP complicated by generalized peritonitis (GP) is yet controversial. The present study aimed to highlight the efficacy and safety of the laparoscopic approach in AP complicated with GP.
Settings
This study took place in Mansura University Hospital, Faculty of Medicine.
Patients and methods
From September 2010 to May 2019, the patients were randomly assigned to undergo either an LA or exploratory open appendectomy (EOA). The demographics of the patient and preoperative parameters, including radiological evaluation, intraoperative finding, and postoperative complications, were evaluated. The follow-up period was 8 months to 2 years (mean: 18 months).
Main outcomes
The primary outcome of this study was early postoperative complications.
Results
A total of 120 patients, aged 38±11 years, were analyzed. Of these, 69 (57.5%) patients underwent LA, whereas two (2.9%) were converted to open surgery. All patients presented with diffuse peritonitis. The duration of operation was longer in the laparoscopic group than in the EOA group (=0.001). No differences were detected in the preoperative patient comorbidities. The rate of postoperative surgical infection and intra-abdominal abscess was similar in the laparoscopic and EOA groups (=0.3040 and 0.0754, respectively). However, the length of hospital stay was shorter in the laparoscopic group than that in the EOA group (=0.001).
Conclusions
The laparoscopic approach for appendicitis complicated by GP is better than the open approach, and hence, it must be the first choice for surgery in the case of clear preoperative diagnosis.

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