EMERGENCY LAPAROSCOPIC SURGERY IN CASES OF RUPTURED APPENDICITIS

 Acute appendicitis is one of the most frequently seen surgical callers in emergency departments but is routinely managed as an uncomplicated procedure until it becomes complicated (e.g., through rupture). Laparoscopic appendectomy is thought to be a safe alternative to open appendectomy in managing uncomplicated appendicitis, however it has yet to be conclusively shown that laparoscopic appendectomy can be safely performed in patients with perforated appendicitis and peritonitis. To investigate the safety of laparoscopic appendectomy in patients with perforated appendicitis and peritonitis, we performed a retrospective cohort study using data collected from patients imaging-confirmed to have ruptured appendicitis at a tertiary hospital who underwent laparoscopic appendectomy during a three-year period (from January 1 2018 to December 31 2020). We reviewed each patient's medical record for the following: operative variables (operative time, conversion from laparoscopy to open surgery), postoperative recovery (hospital length of stay, readmission), and complications (intra-abdominal abscess, superficial wound infection, deep wound infection) using descriptive statistics.

The mean operative time for laparoscopic appendectomy in patients with ruptured appendicitis was 72.4 minutes, and laparoscopic appendectomy was converted to open appendectomy in 4.9% of cases. The mean length of stay after laparoscopic appendectomy for ruptured appendicitis was 4.8 days. The total complication rate for laparoscopic appendectomy in patients with ruptured appendicitis was 14.1% for those who developed an intra-abdominal abscess and 2.7% for those who developed a superficial wound infection. The appendiceal stump was managed by endoloops (73.4%) and staplers (22.3%).

In experienced hands and using standardized techniques for lavage and removal of the appendix, laparoscopic appendectomy for ruptured appendicitis is a safe and effective procedure with low rates of wound infection and fast recovery time. Laparoscopic appendectomy should be the primary surgical method of management for patients with complicated appendicitis.