Comparing laparoscopic appendectomy to open appendectomy in managing generalised purulent peritonitis from complicated appendicitis: the uncharted path.

Background: The objective of the study was to compare the outcomes of patients with generalised purulent peritonitis from complicated appendicitis diagnosed intraoperatively who were managed laparoscopically to those managed via the open approach in a single institution.

Method: Data were collected from all cases admitted at Sebokeng Hospital, Johannesburg, over the past two years (2008 and 2009) with an intraoperative diagnosis of generalised purulent peritonitis from complicated appendicitis. Cases managed laparoscopically or by the open approach were analysed. The demographic findings, theatre duration, complications, days to the commencement of a full ward diet and the length of the hospital stay were the analysed parameters.

Results: One hundred and twenty appendectomies with generalised purulent peritonitis were performed during the study period. Of these, 58 patients underwent open appendectomy, and 62 patients had laparoscopic appendectomy. Both groups were comparable with regard to the demographics and preoperative findings. Theatre duration was significantly higher in the laparoscopic appendectomy group -116 minutes for a laparoscopic appendectomy compared to 87 minutes for an open appendectomy. The rate of intra-abdominal sepsis was also higher in the laparoscopic appendectomy group - 13% for a laparoscopic appendectomy, and 9% for an open appendectomy. A statistically significant decrease in the wound sepsis rate was shown in the laparoscopic appendectomy group. No statistical significant difference was demonstrated with regard to other postoperative complications, days to the commencement of a full ward diet and the length of hospital stay in both groups. More time (an average of 3.7 days) was spent in the intensive care unit and high care unit by those in the open appendectomy group, than those in the laparoscopic appendectomy group (an average of 2.0 days). However, age, duration of symptoms, clinical presentation and white blood cell count were influencing factors on the outcome measures in the open appendectomy group.

Conclusion: Generalised purulent peritonitis from complicated appendicitis can be managed successfully laparoscopically. Both approaches are feasible, safe and have comparable outcomes. The laparoscopic approach resulted in fewer postoperative wound sepsis complications.