Comparison of laparoscopic, open, and converted appendectomy for perforated appendicitis

Background: Perforated appendicitis is associated with a significant risk o f postoperative abdominal and wound infection. Only a few controversial stu dies evaluate the role of laparoscopy in perforated appendicitis. The signi ficance of conversion from laparoscopy to open appendectomy for perforated appendicitis is not well defined. Statistical analysis was performed using Student's t-test. Methods: Data on 52 patients with perforated appendicitis were prospectivel y collected and retrospectively reviewed. Among these patients, 18 had lapa roscopic appendectomies (LA); 24 had open appendectomies (OA); and 10 had c onverted appendectomies (CA). The indications for either method were based on the attending surgeons's philosophy. Laparoscopic appendectomy was perfo rmed using a retro-grade stapler technique. Operative time, hospital stay, ability to tolerate a liquid diet, and postoperative infectious complicatio ns were documented. Results: No statistically significant difference in the operative time in m inutes was found between the LA (114 +/- 29.3), CA (120.0 +/- 32.2), and OA (105.8 +/- 64.1) groups (p = NS). There was no statistically significance difference in length of stay (days) between the LA (9.2 +/- 4.1), OA (10.5 +/- 3.3), and CA (10.0 +/- 1.8) groups. The wound infection rate was less f requent in the LA group (0%) than in OA (14%) and CA (10%) groups. The rate of intra-abdominal abscess infections (IAAs) and ileus were 22% and 28%, r espectively, in LA group, 38% and 29%, respectively, in OA group, and 60% a nd 50%, respectively, in CA group. Conclusions: No difference in the rate of postoperative intra-abdominal abs cesses exists between laparoscopic and open appendectomy for perforated app endicitis. Wound infections and ileus complicate the postoperative course o f patients after laparoscopic appendectomy less frequently than after open appendectomy. The conversion of laparoscopic to open appendectomy for perfo rated appendicitis is associated with increased postoperative morbidity.