LAPAROSCOPIC APPENDECTOMY FOR COMPLICATED APPENDICITIS

Background: Acute gangrenous and perforating appendicitis are associat ed with an increased risk for postoperative complications and have bee n considered a relative contraindication of laparoscopic appendectomy. Objective: To determine the complication rate following laparoscopic appendectomy for gangrenous or perforating appendicitis. Design: A ret rospective analysis of patients who underwent laparoscopic appendectom y for gangrenous or perforating appendicitis. Setting: A multispecialt y clinic. Results: Fifteen patients underwent laparoscopic appendectom y for gangrenous appendicitis and 19 patients for perforating appendic itis. In the gangrenous appendicitis group, average operating time was 85 minutes; average length of hospitalization, 2 days; and morbidity rate, 7% (one patient with abdominal abscess). The perforating appendi citis group had an average operating time of 84 minutes, hospitalizati on of 7 days, and a morbidity rate of 42%. This morbidity included fiv e patients (26%) who developed intra-abdominal abscesses, two patients (10%) in whom wound infections developed, and one patient (5%) who di ed of Candida sepsis and multisystem organ failure. Conclusions: Lapar oscopic appendectomy can be safely performed in gangrenous appendiciti s. Laparoscopic appendectomy for perforating appendicitis is associate d with prolonged hospitalization and an increased risk for infectious complications.