Laparoscopic versus open appendicectomy in the management of complicated appendicitis

Abstract

AA is one of the most common emergency surgical presentations with a lifetime risk of 7% (Hajibandeh et al., 2020). According to collected data, the annual incidence of AA is almost 90 per 100,000. CA, defined as histologically or intraoperatively diagnosed gangrenous or perforated appendicitis, suppurative appendicitis or appendicitis with an abscess, phlegmon formation, periappendicular mass or fecal peritonitis; represents around ⅓ of all cases It is more likely at the extremes of age, occurring in approximately 40% of patients under 10 years and 50% of those over 50 years (Buckius et al., 2012). Whilst appendicectomy for the treatment of uncomplicated appendicitis has been the mainstay of treatment, its role in CA including appendicular abscess and phlegmon has been unclear (Cheng et al., 2017). Moreover, appendicular abscess and phlegmon have been associated with high risk of morbidity following operative intervention including wound infection, ileus, pelvic abscess and re-operation although classically mortality is less than 1% with good clinical prognosis (Markides et al., 2010). As a result, several reviews have recommended conservative initial management with antibiotics and/or radiological drainage as a safe treatment (Cheng et al., 2015). Over the last three decades with the advent of laparoscopic surgery and the more widespread use of laparoscopy, CA has been increasingly managed laparoscopically, with up to 67% of cases of CA performed laparoscopically in 2011 in the USA (Masoomi et al., 2014).