Outcomes of Complicated Acute Appendicitis at a Central Academic Hospital in Johannesburg South Africa

Abstract

Background: Laparotomy remains the most practiced approach for complicated appendicitis in some countries, including South Africa. This study compared the outcomes of patients who had a laparotomy or laparoscopic surgery for complicated acute appendicitis. Methods: A retrospective review of patient records that had either a laparotomy and appendectomy or a laparoscopic appendectomy was undertaken. Data collected included demographic information, duration of symptoms, length of hospital stay, time to surgery, type of surgery, need for ICU admission, number of relooks, microbiology and outcomes. Records of 200 patients of whom 62 patients (31.0%) had a laparoscopic appendectomy and 138 patients (69.0%) had an open appendectomy were included. Eighty-two patients (59.4%) who had an open appendectomy had a midline laparotomy. Postoperative complications developed in 46.4% of laparotomy vs 17.7% of laparoscopy patients (P<0.001). The mortality rate was 9.5% overall, with significantly higher mortality in the laparotomy group at 13.0% vs 1.6% in the laparoscopic group (P=0.009). Patients who died had significantly higher rates of complications and need for relook surgery (P<0.001). Histology showed a normal appendix in 13/138 patients (9.4%), granulomatous lesions and parasitic infection each in 5 patients (3.6%). Conclusion: The majority of patients with complicated acute appendicitis had a appendectomy via laparotomy and this group of patients developed significantly more postoperative complications. The mortality rate was also significantly higher in patients who underwent a laparotomy