Retrospective Study
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World J Gastroenterol. Aug 21, 2014; 20(31): 10938-10943
Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10938
New strategy during complicated open appendectomy: Convert open operation to laparoscopy
Jin-Hui Zhu, Wei Li, Kai Yu, Jia Wu, Yun Ji, Jian-Wei Wang
Jin-Hui Zhu, Wei Li, Kai Yu, Yun Ji, Department of General Surgery and Laparoscopic Center, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Jia Wu, Department of General Surgery, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
Jian-Wei Wang, Department of Oncology, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Author contributions: Wang JW and Zhu JH designed research; Zhu JH and Li W performed research; Wu J contributed new reagents or analytic tools; Yu K and Ji Y analyzed data; Zhu JH wrote the paper.
Correspondence to: Jian-Wei Wang, MD, Associate Chief, Department of Oncology, the Second Affiliated Hospital Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China. jwewawewa@163.com
Telephone: +86-571-87784695 Fax: +86-571-87022776
Received: January 12, 2014
Revised: February 24, 2014
Accepted: April 21, 2014
Published online: August 21, 2014
Abstract

AIM: To introduce a new strategy during complicated open appendectomy - converting open operation to laparoscopy.

METHODS: We retrospectively reviewed databases at two institutions between October 2010 and January 2013, identifying 826 patients who had undergone complicated appendectomy for histologically confirmed acute or chronic appendicitis. They included 214 complicated appendectomies: 155 lengthened-incision open appendectomies (LIA group) and 59 open appendectomies with conversion to laparoscopy (OACL group).

RESULTS: A total of 214 patients with complicated appendectomies were included in the study, including 155 cases of LIA and 59 cases of OACL. No major complication leading to death occurred in the study. Patient characteristics of the two groups were similar. Several parameters showed a significant difference between the two groups. For the OACL vs LIA groups they were, respectively: incision length (3.8 ± 1.4 cm vs 6.2 ± 3.5 cm, P < 0.05); time to flatus recovery (2.3 ± 0.6 d vs 4.2 ± 0.8 d, P < 0.05), drainage rate (61.0% vs 80.0%, P < 0.05); pain level (3.6 ± 1.8 vs 7.2 ± 2.4, P < 0.05); hospital stay (5.1 ± 2.7 d vs 8.7 ± 3.2 d, P < 0.05); complication rate (8.5% vs 14.7%, P < 0.05). Other factors showed no significant differences.

CONCLUSION: Lengthened-incision open appendectomy increases the incidence of complications and prolongs the hospital stay. Conversion of open to laparoscopic appendectomy is feasible and efficient in complicated cases. It decreases the rate of incisional and abdominal infections, allows faster return of bowel movements, and shortens the hospital stay.

Keywords: Complicated appendectomy, Open, Laparoscopy, Conversion, Complication

Core tip: In the present paper, we introduce a new strategy during complicated open appendectomy: convert to laparoscopy. It is an effective and safe technique when comparing the length of incisions. Moreover, in this report, we describe some techniques applied in laparoscopic appendectomy to minimize complications.