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Laparoscopic versus open approach for diffuse peritonitis from appendicitis ethiology: a subgroup analysis from the Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) study

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Abstract

Diffuse peritonitis represents a life-threatening complication of acute appendicitis (AA). Whether laparoscopy is a safe procedure and presents similar results compared with laparotomy in case of complicated AA is still a matter of debate. The objective of this study is to compare laparoscopic (LA) and open appendectomy (OA) for the management of diffuse peritonitis caused by AA. This is a prospective multicenter cohort study, including 223 patients with diffuse peritonitis from perforated AA, enrolled in the Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) study from February to May 2018. Two groups were created: LA = 78 patients, mean age 42.51 ± 22.14 years and OA = 145 patients, mean age 38.44 ± 20.95 years. LA was employed in 34.98% of cases. There was no statically significant difference between LA and OA groups in terms of intra-abdominal abscess, postoperative peritonitis, rate of reoperation, and mortality. The wound infection rate was higher in the OA group (OR 21.63; 95% CI 3.46–895.47; P = 0.00). The mean postoperative hospital stay in the LA group was shorter than in the OA group (6.40 ± 4.29 days versus 7.8 ± 5.30 days; P = 0.032). Although LA was only used in one-third of cases, it is a safe procedure and should be considered in the management of patients with diffuse peritonitis caused by AA, respecting its indications.

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Authors and Affiliations

  1. Surgery Department, School of Medical Sciences and Health of Juiz de Fora (SUPREMA), University Hospital Therezinha de Jesus, Rua Senador Salgado Filho 510/1002, Bairro Bom Pastor, Juiz de Fora, Minas Gerais, CEP: 36021-660, Brazil

    Carlos Augusto Gomes

  2. Department of Surgery, Macerata University Hospital, Macerata, Italy

    Massimo Sartelli

  3. Department of Surgical Science, Policlinico Universitario “D. Casula”, University of Cagliari, Cagliari, Italy

    Mauro Podda

  4. Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 201, Cambridge, UK

    Salomone Di Saverio

  5. General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy

    Federico Coccolini

  6. Hospital de Clínicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay

    Helmut A. Segovia-Lohse

  7. Department of General and Minimally Invasive Surgery, Paris Poissy Medical Center, Poissy, France

    Belinda De Simone

  8. Department of Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy

    Fausto Catena

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  1. Carlos Augusto Gomes
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Contributions

CAG, MS, MP, SDS, FC, LA, HAS-L, BdS and FC: Study conception and design, acquisition, interpretation and analysis of data; drafting and critically revising the article for important intellectual content; and final approval of the version to be published.

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Correspondence to Carlos Augusto Gomes or Belinda De Simone.

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Research involving human participants and/or animals

Data were extrapolated from WSES PIPAS study. The data was completely anonymised, and no patient or hospital information was collected in the database. The study protocol was approved by the board of the WSES, and the study was conducted under its supervision. The board of the WSES granted the proper ethical conduct of the study.

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Gomes, C.A., Sartelli, M., Podda, M. et al. Laparoscopic versus open approach for diffuse peritonitis from appendicitis ethiology: a subgroup analysis from the Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) study. Updates Surg 72, 185–191 (2020). https://doi.org/10.1007/s13304-020-00711-y

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