Laparoscopic versus open surgery for complicated appendicitis: a randomized controlled trial to prove safety

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Web End = Surg Endosc (2015) 29:20272032 DOI 10.1007/s00464-014-3906-y

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Web End = Laparoscopic versus open surgery for complicated appendicitis: a randomized controlled trial to prove safety

John-Edwin Thomson Deirdr Kruger Christine Jann-Kruger

Akos Kiss J. A. O. Omoshoro-Jones Thifheli Luvhengo

Martin Brand

Received: 16 May 2014 / Accepted: 10 September 2014 / Published online: 16 October 2014 Springer Science+Business Media New York 2014

AbstractBackground To date, no randomized control trial has been performed comparing open appendectomy (OA) to laparoscopic appendectomy (LA) in complicated appendicitis. A systematic review and meta-analysis in 2010 concluded LA is advantageous to OA with less surgical site sepsis in complicated appendicitis; however, the level of evidence is weak (level 3a). The aim of the study was to determine whether LA is safe in the treatment of complicated appendicitis. Primary outcome included all-cause mortality and procedure-related mortality; secondary outcomes included intra-operative duration, rates of wound sepsis and re-intervention, length of hospital stay and re-admission rates. Methods One hundred and fourteen patients were randomized prospectively to either OA or LA using a computer-generated blind method. Patients who were either less than 12 years of age, had previous abdominal surgery or were pregnant were excluded. A team of senior surgeons capable of doing both OA and LA performed all procedures. Results The intra-operative duration, the rate of wound sepsis, the number of re-operations, the length of hospital stay and the rate of re-admissions between the OA and LA groups did not differ statistically.

Conclusion Laparoscopic appendectomy is safe in complicated appendicitis. Current Control Trials (ISRCTN922 57749)

Keywords Laparoscopic Open Appendicitis

Complicated Appendectomy Uncomplicated

Appendectomy is the most commonly performed emergency surgical procedure, with an individual life time incidence of 68 % [1]. Since its introduction by McBurney [2] over a century ago, open appendectomy (OA) has been the gold standard for the treatment of appendicitis. However, with the advent of laparoscopy and the introduction of a laparoscopic appendectomy (LA) by Semm in 1983 [3], LA has become an alternative surgical approach for the treatment of appendicitis. Randomized control trials...