The road to ambulatory laparoscopic management of perforated appendicitis

• Published in: The American journal of surgery Vol. 179; no. 1; pp. 63 - 66
• Main Authors: Alvarez, Carlos, Voitk, Andrus J
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.01.2000; Elsevier; Elsevier Limited
• Subjects: Abdomen; Abscesses; Adult; Ambulatory Surgical Procedures; Antibiotics; Appendectomy; Appendectomy - methods; Appendicitis; Appendicitis - surgery; Biological and medical sciences; Clinical Competence; Complications; Conversion; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Intestinal Perforation - surgery; Laparoscopy; Learning; Length of Stay; Male; Management; Medical sciences; NMR; Nuclear magnetic resonance; Other diseases. Semiology; Pain; Patients; Perforation; Retrospective Studies; Rupture, Spontaneous; Skills; Stomach, duodenum, intestine, rectum, anus; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgeons; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Time Factors; Ultrasonic imaging; Visiting nurses; Ontario Canada; Canada; Human; Endoscopic surgery; Appendectomy; Appendicitis; Perforation; Laparoscopy; Retrospective; Result; Treatment; Vermiform appendix; Surgery; Digestive diseases; Intestinal disease; Endoscopy; Ambulatory; Technique
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(99)00270-6

Background: This study examines the contribution of increased laparoscopic skills to ambulatory management of perforated appendicitis. Methods: All 38 perforated appendicitides from 151 laparoscopic appendectomies done by one surgeon were studied and ambulatory management (discharge less than 24 hours after surgery) of the last 18 perforations reported. Results: Over 4 years, rate of attempted laparoscopic appendectomy rose from 67% to 100% for perforations. Conversion rate fell from 100% to 22%. Ileus and pain control were not problems for most laparoscopic perforations, so by the end of 1997, experience suggested these patients might be discharged within 24 hours. Ambulatory rate was 57% (conversions excluded). There were no readmissions for wound infections or postoperative abdominal abscesses. Conclusions: Increasing laparoscopic skills allows laparoscopic treatment of complicated appendicitis with a low conversion rate and no infectious complications. Over one half of these patients can be managed as outpatients without jeopardy to outcome.