Laparoscopic Appendectomy for Complicated Appendicitis

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)