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Laparoscopic Appendectomy for Complicated Appendicitis

Richard C. Frazee, MD; William T. Bohannon, MD
Arch Surg. 1996;131(5):509-512. doi:10.1001/archsurg.1996.01430170055010.
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Background:  Acute gangrenous and perforating appendicitis are associated with an increased risk for postoperative complications and have been considered a relative contraindication of laparoscopic appendectomy.

Objective:  To determine the complication rate following laparoscopic appendectomy for gangrenous or perforating appendicitis.

Design:  A retrospective analysis of patients who underwent laparoscopic appendectomy for gangrenous or perforating appendicitis.

Setting:  A multispecialty clinic.

Results:  Fifteen patients underwent laparoscopic appendectomy for gangrenous appendicitis and 19 patients for perforating appendicitis. In the gangrenous appendicitis group, average operating time was 85 minutes; average length of hospitalization, 2 days; and morbidity rate, 7% (one patient with abdominal abscess). The perforating appendicitis group had an average operating time of 84 minutes, hospitalization of 7 days, and a morbidity rate of 42%. This morbidity included five patients (26%) who developed intra-abdominal abscesses, two patients (10%) in whom wound infections developed, and one patient (5%) who died of Candida sepsis and multisystem organ failure.

Conclusions:  Laparoscopic appendectomy can be safely performed in gangrenous appendicitis. Laparoscopic appendectomy for perforating appendicitis is associated with prolonged hospitalization and an increased risk for infectious complications.(Arch Surg. 1996;131:509-512)


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