Is Laparoscopic Appendectomy a Safe Procedure?

Background: Laparoscopic appendectomy (LA) is a common procedure, considered to be a safe alternative to conventional open appendectomy (OA). LA is known to reduce parietal scarring, offers a shortened hospital stay and an earlier return to normal activities. Acute gangrenous and perforated appendicitis may be associated with an increased risk for postoperative complications following laparoscopic appendectomy.
Objective: To determine the complication rate following LA.
Material and methods: Between January 2000 and November 2003, 323 consecutive emergency appendectomies were performed (311 LA, 5 OA and 7 conversions). A retrospective analysis of LA was performed with evaluation of complication rate (fever, pain, intra-abdominal infection or abscess and abdominal wall infection), duration of preceding symptoms, interval between admission and operation, length of the operation, whether the performing surgeon was a resident or a senior surgeon, and the length of hospital stay (LOS).
Results: Two hundred patients (64.3%) were males and mean age was 35 years. Mean waiting time for surgery was 9.4 hours, mean operating time 48 minutes and conversion rate was 2.2%; mean LOS was 3.05 days. Histology showed acute inflammation in 81% (acute appendicitis in 54.34%, phlegomonous appendicitis – 17.36%, perforated or gangrenous appendicitis – 9.00%). There was a 10.6% overall incidence of infectious complications, 9.64% of readmissions and mortality was 0.
Conclusions: It appears that in the current study, the overall complication rate following LA is higher than expected, and tends to be even higher for complicated appendicitis. This needs further evaluation.