Early Laparoscopic Appendectomy Results In Superior Surgical Outcomes For Adult Acute Appendicitis – A Prospective Observational Study

Abstract

Background: Laparoscopic appendectomy has been widely performed for the treatment of acute appendicitis. However, there is still controversy in the surgical timing. The objective of this study was to evaluate for an association between duration of symptoms with clinical outcomes to create a timeline of the pathological change in acute appendicitis. Methods: Adult patients underwent laparoscopic appendectomy for acute appendicitis from November 2016 to October 2017 were allocated into 5 groups according to the symptom duration (group 1: <24h; group 2: 24-47h; group 3:48-71h; group 4:72-95h; group 5:≥96h). The onset time of appendicitis was prospectively collected. Length of operative time, appendiceal perforation, positive ascitic culture and conversion to open surgery were analyzed. Statistical analysis was completed using Kruskal-wallis and Chi-squared test. Results: 211 adult patients underwent laparoscopic appendectomy surgery and confirmed acute appendicitis were allocated into 5 groups (group 1: 44; group 2: 75; group 3: 47; group 4: 28; group 5: 17). The operative time of group 4,5 were significantly longer than group 1,2,3, respectively (p<0.05). The incidence of perforation were significantly increased in the groups 3,4,5 than groups 1,2, respectively (p<0.05). In the group 5, the ratio of conversion to open is significantly elevated compared with group1,2 (p<0.05). The positive culture rate increased in the group 4 than in the group 1,2,3 (p<0.05). Conclusion: Early laparoscopic appendectomy may lead to better outcomes for adult acute appendicitis.