Laparoscopic treatment of presumed perforated appendicitis in consecutive patients.

Park, Hyoung-Chul; Kim, Byung-Seup; Lee, Bong Hwa

PURPOSE The aim of the present study was to determine whether the laparoscopic approach is effective in the prompt diagnosis and treatment in consecutive patients with presumed perforated appendicitis. METHODS Over a period of 2 years, 203 patients were tentatively diagnosed with perforated appendicitis on the basis of radiological findings. We performed laparoscopic procedure and evaluated the outcomes, including the incidence of alternative pathologies. RESULTS Most patients (188/203, 92.6%) were treated with laparoscopic appendectomy or partial cecectomy. Five (2.4%) cases were converted to open surgery. Alternative pathologies were found in 24 patients (12%). Of these, 8 patients underwent laparoscopic ileocolic resection (4 diverticulitis, 2 Crohn disease, 1 cystadenoma, and 1 tuberculosis) and 4 patients (2 carcinoid tumors and 2 cancers) underwent subsequent laparoscopic right hemicolectomy. Complications developed in 23 patients (11.3%). CONCLUSIONS Laparoscopy for presumed perforated appendicitis is an effective treatment and avoids the delay arising from a late diagnosis.