Is laparoscopic surgery the answer to generalised purulent peritonitis from complicated appendicitis?
Date
2012-01-17
Authors
Ndofor, Brown Chwifeh
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Abstract
Aim
To compare the different outcomes in a single institution between patients with generalised
purulent peritonitis from complicated appendicitis diagnosed intraoperatively which were
managed laparoscopically to those managed via the open approach.
Methods
Data was collected from all cases admitted at Sebokeng Hospital over the past two years
(2008 & 2009) with an intraoperative diagnosis of generalised purulent peritonitis from
complicated appendicitis. Cases which were managed laparoscopically or by the open
approach were analysed.
The parameters analysed were the demographic findings, the theater duration, complications,
and days to the commencement of full ward diet, and length of hospital stay.
Results
During the study period, a total of 120 cases of appendicectomies with generalised purulent
peritonitis were performed. Of these, 58 cases underwent open appendicectomy (OA) and 62
cases had laparoscopic appendicectomy (LA). Both groups were comparable in the
demographics and preoperative findings.
The theater duration was significantly higher in the LA group (115.8 minutes for LA
compared to 86.7 minutes for OA. The rate of intraabdominal sepsis was also higher in the
LA group (12.9% for LA and 8.6% for OA). Both groups showed no statistical significant
difference between the wound sepsis or port site sepsis rate, the days to commencement of
full ward diet and length of hospital stay. More time was spent in ICU/HCU in the OA group
an average of 3.7 days as opposed to 2 days in the LA group.
However age, the duration of symptoms, the clinical presentation and the white blood cell
count (WBC) were influencing factors to the outcome of the OA group. Conclusion
Generalised purulent peritonitis from complicated appendicitis can be managed successfully
laparoscopically. Both approaches are feasible, safe and have comparable outcomes. Where
facilities are adequately skilled and resourced, the laparoscopic approach should be
considered the procedure of choice for complicated purulent appendicitis because it is less
influenced by preoperative findings and shows a trend towards less postoperative
complications.