Results of laparoscopic vs. conventional appendectomy in complicated appendicitis

BACKGROUND: Although many trials show some advantages of laparoscopic appen dectomy over open appendectomy, the value of laparoscopic appendectomy is s till controversial. Specifically the question of whether there are benefits of laparoscopic appendectomy over open appendectomy in complicated appendi citis remains to be answered. METHODS: Of 1,106 consecutive appendectomies (717 laparoscopic appendectomies, 330 open appendectomies, and 59 conversio ns) between 1989 and 1999, the results of 299 patients with complicated app endicitis (defined by perforation, abscess, or peritonitis) were analyzed r etrospectively to compare the complications of laparoscopic appendectomy an d conversion (intention-to-treat group) with those of open appendectomy. RE SULTS: Complicated appendicitis (n = 299) was treated by laparoscopic appen dectomy in 171 patients, by open appendectomy in 82 patients. and by conver sion in 46 patients. Laparoscopic appendectomy and conversion showed fewer abdominal wall complications than open appendectomy (13/2171- 6 percent vs. 15/82; 18.3 percent; P < 0.003), which led to a decrease of the total comp lication rate in the intention-to-treat group (21/217; 9.7 percent vs. 19/8 2; 23.1 percent; P = 0.004). The rate of intra-abdominal abscess formation was nearly the same after laparoscopic appendectomy (4.1 percent) and open appendectomy (4.9 percent). The total complication rate was higher in compl icated appendicitis than in acute appendicitis (P < 0.005) but was independ ent of the laparoscopic technique. The conversion rate was higher in compli cated appendicitis than in acute appendicitis (21.2 vs. 2.3 percent: P < 0. 001). CONCLUSION: In comparison with open appendectomy, laparoscopic append ectomy (by itself and in an intention-to-treat view) leads to a significant reduction of early postoperative complications in complicated appendicitis and therefore should be considered as the procedure of choice.