Resumo

ONIEVA, Francisco Gabriel et al. Laparoscopic approach versus classic open procedure in the treatment of acute appendicitis. rev. colomb. cir. [online]. 2017, vol.32, n.1, pp.26-31. ISSN 2011-7582.  https://doi.org/10.30944/20117582.4.

Background: Acute appendicitis is one of the most frequent causes of emergency surgical intervention in patients with acute abdomen. Material and methods: Retrospective observational study of 294 appendectomies performed at the Llerena-Zafra Hospital Center, Badajoz, Spain, between January 2012 and July 2014, comparing laparoscopic appendectomy (LA) and open (OA) analyzing possible factors associated with surgical morbidity. LA was performed in 179 patients (60.9%) and OA in 115 (39.1%) Results: Surgical time was longer in LA 53.56 ± 22.62 versus 41.87 min ± 16.86 min in OA (p<0.001). There were also differences in the use of drainage, most used in LA (63.7% vs. 19.5%, p<0.001). The conversion rate was 1.1%. More surgical complications developed in the OA group (p=0.01), highlighting increased rate of surgical site infection (p<0.001) and intra-abdominal abscesses (p=0.04). We registered 14.3% blank appendectomies, more common in LA (17.9% vs.8.7%, p=0.02). The average hospital stay was 3.36 ± 3.48 days, being lower in LA (2.99 ± 2.40 days vs. 3.95 ± 4.65 days, p=0.01). Multivariate analysis showed that the independent variables lengthening hospital stay were chronic renal failure (p<0.001), surgical intervention as OA (p = 0.02), onset of oral feeding tolerance after the first 24 hours (p<0.001), and the development of surgical complication (p <0.001). Discussion: In our series, laparoscopic appendectomy is a safe procedure, with low conversion rate, lower complication rates and shorter hospital stay, but it does take longer operating time.

Palavras-chave : acute abdomen; appendicitis; appendectomy; laparotomy; laparoscopy; Quality Assurance; Health Care.

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