Open versus laparoscopic operation for perforated appendicitis - A comparative study

Introduction: Laparoscopic therapy of complicated appendicitis is still discussed controversially. This retrospective study compared the clinical results of open and laparoscopic appendectomy in a single centre. Patients and Methods: Within a period of three years (1999 to 2001) 493 patients with suspected acute appendicitis were operated prospectively at a German district hospital (250 open appendectomies, 243 laparoscopic appendectomies). Twenty percent of the patients in every group had a complicated appendicitis (48 open, 44 laparoscopic appendectomies) and were analysed retrospectively considering demographic data, operative time, body mass index, preoperative inflammatory parameters (white blood cell count, C-reactive protein and body temperature) and postoperative complication rate. Results: Both groups were comparable with regard to demographic data. One patient of the laparoscopic group needed an open operation (conversion rate 2.3%). The body mass index of the laparoscopic group was significantly higher (26.3 vs. 24.1 kg/m(2)). Preoperative white blood cell count, C-reactive protein, body temperature as well as postoperative antibiotic therapy and analgesics requirement were comparable in both groups. There was no significant difference between the length of operative time (open 48 min, laparoscopic 53.5 min). The postoperative hospital stay was significantly shorter in the laparoscopic group (8 vs. 9 days, p = 0.032). Complication rate was significantly lower in the laparoscopic group (11.5 vs. 35 %, p = 0.014). Conclusion: Laparoscopic appendectomy is a safe procedure for the treatment of complicated appendicitis with a significantly decreased complication rate and shorter postoperative stay.