Perforating appendicitis - An indication for laparoscopy?

Background: This pilot study was performed to reassess the widespread postu late that laparoscopic surgery is contraindicated in cases of perforating a ppendicitis. Methods: A total of 75 children (appendiceal perforation: n = 67; perityphl ic abscesses and peritonitis: n = 8) were analyzed in a prospective nonrand omized trial. Ten of them were treated by laparoscopic appendectomy. Results: In the laparoscopy group, both pain and hospitalization were less time-consuming (i.e., by 50% and 19%, respectively). Antibiotics use was do wn from 2.6 over 6 days to 3.2. over 5.5 days, while the duration of surger y was up by 52%. Wound healing disturbances occurred in 10% (n = 1) and pos toperative fever in 50% (n = 5) of patients, compared to 14% (n = 9) and 15 % (n = 10) in the group treated by open surgery. All severe complications r equiring reintervention (10%; massive subcutaneous abscess, n = 3; retrocol ic abscess, n = 2; adhesion-related ileus, n = 3; appendicular stump, n = 1 ) were associated with open surgery. Conclusions: There was not a single major complication in the laparoscopy g roup. These unexpected results are in contrast to previous reports and have prompted us to initiate a prospective randomized trial.