Joachim Wilfried Heise1, Heiner Kentrup2, Christoph Gerhart Dietrich3, Ansgar Cosler4, Dolores Hübner5, Werner Krumholz6. 1. Department of General, Visceral and Thyroid Surgery, Bethlehem Gesundheitszentrum Stolberg (Rhld.), Stolberg, Germany. 2. Department of Pediatrics, Bethlehem Gesundheitszentrum Stolberg (Rhld.), Stolberg, Germany. 3. Department of Internal Medicine, Bethlehem Gesundheitszentrum Stolberg (Rhld.), Stolberg, Germany. 4. Department of Gynecology and Obstetrics, Bethlehem Gesundheitszentrum Stolberg (Rhld.), Stolberg, Germany. 5. Department of Radiology and Pediatric Radiology, Bethlehem Gesundheitszentrum Stolberg (Rhld.), Stolberg, Germany. 6. Department of Anesthesiology, Bethlehem Gesundheitszentrum Stolberg (Rhld.), Stolberg, Germany.
Abstract
INTRODUCTION: Since conservative antibiotic treatment in uncomplicated appendicitis might not solve the clinical problem definitively, it has to compete with the results of today's laparoscopic appendectomy. METHODS: In a county hospital, accommodating also a pediatric department, all cases of appendectomy for suspected appendicitis over 15 years were analyzed retrospectively for the following items: beginning of symptoms, time from admission to surgery, surgical technique as "open," "laparoscopic" or "converted," if perforated at operation and histological confirmation of acute inflammation. Surgical morbidity was detected in distinct categories. To evaluate changes over time, 3 time periods of 5 years each were defined. RESULTS: Resulting in a total of 1,956 cases there were 731 in group I, 633 in group II and 592 in group III within the 3 time periods, respectively. The median age was 17 years. The percentage of perforations was 16.8%. Those patients had - with 47 compared to 27 h - a significantly prolonged time from the beginning of symptoms to admission (p = 0.0001). The proportion of laparoscopic surgery rose from 83.3 (group I) to 98.3% (group III; p = 0.0001). The median postoperative hospital stay diminished from 4 to 3 days in nonperforated (p = 0.0001) and from 8 to 7 days in perforated cases (p = 0.0009). Surgical morbidity was reduced from 4.1% in the first to 1.7% in the third observation period (p = 0.0144). There were no surgical site infections during the last 5 years. CONCLUSIONS: Timely laparoscopic appendectomy in case of suspected appendicitis can be offered with an extraordinary low morbidity. Taking into account the complete solution of the otherwise pending threat, compared to conservative antibiotic treatment, it is safe and definitive.
INTRODUCTION: Since conservative antibiotic treatment in uncomplicated appendicitis might not solve the clinical problem definitively, it has to compete with the results of today's laparoscopic appendectomy. METHODS: In a county hospital, accommodating also a pediatric department, all cases of appendectomy for suspected appendicitis over 15 years were analyzed retrospectively for the following items: beginning of symptoms, time from admission to surgery, surgical technique as "open," "laparoscopic" or "converted," if perforated at operation and histological confirmation of acute inflammation. Surgical morbidity was detected in distinct categories. To evaluate changes over time, 3 time periods of 5 years each were defined. RESULTS: Resulting in a total of 1,956 cases there were 731 in group I, 633 in group II and 592 in group III within the 3 time periods, respectively. The median age was 17 years. The percentage of perforations was 16.8%. Those patients had - with 47 compared to 27 h - a significantly prolonged time from the beginning of symptoms to admission (p = 0.0001). The proportion of laparoscopic surgery rose from 83.3 (group I) to 98.3% (group III; p = 0.0001). The median postoperative hospital stay diminished from 4 to 3 days in nonperforated (p = 0.0001) and from 8 to 7 days in perforated cases (p = 0.0009). Surgical morbidity was reduced from 4.1% in the first to 1.7% in the third observation period (p = 0.0144). There were no surgical site infections during the last 5 years. CONCLUSIONS: Timely laparoscopic appendectomy in case of suspected appendicitis can be offered with an extraordinary low morbidity. Taking into account the complete solution of the otherwise pending threat, compared to conservative antibiotic treatment, it is safe and definitive.
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