Safety and efficacy of laparoscopic approach for widespread appendicular peritonitis

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OBJECTIVE

To analyze treatment outcomes in patients with acute appendicitis complicated by widespread peritonitis.

MATERIAL AND METHODS

The study included 165 patients acute appendicitis complicated by widespread peritonitis. Inclusion criteria: acute appendicitis complicated by widespread peritonitis MIP grade 1—2 in reactive or toxic phase (grading system by Simonyan K.S.), abdominal cavity index ≤16. Exclusion criteria: MIP grade 3, terminal phase, abdominal cavity index ≥17.

RESULTS

Analysis of postoperative data revealed no correlation between surgical approach and incidence of postoperative intra-abdominal abscesses and infiltrates. In the main group, intra-abdominal abscesses occurred in 4.9% of patients (n=5), infiltrates — 12.8% (n=13). In the control group, these parameters were 4.6% (n=2) and 18.2% (n=8), respectively. We have developed and introduced into clinical practice a differentiated approach to surgical treatment of widespread appendicular peritonitis based on laparoscopic data. Abdominal cavity was intraoperatively assessed. The proposed method included 5 criteria with establishment of appropriate points (min 3, max 14). In case of total score 3—8, laparoscopic approach was preferred. Overall score 9—11 required laparoscopic surgery with subsequent elective repeated laparoscopy, ≥12 scores — intraoperative conversion and open surgery. Thus, subject to the rules of surgical intervention, the number of intra-abdominal complications between laparoscopic and open methods is equalized.

CONCLUSION

The developed differentiated surgical strategy for patients with appendicular peritonitis is effective and reduces the incidence of wound infection, extra-abdominal complications, and hospital-stay, as well as contributes to early rehabilitation of patients.

Keywords:

appendicitis

appendicular peritonitis

laparoscopy

laparoscopic appendectomy

peritonitis severity assessment scale

intra-abdominal abscess

postoperative infiltrate

Authors:

Arutyunyan A.S.

Russian Medical Academy of Continuous Professional Education;
Sklifosovsky Research Institute for Emergency Care

Blagovestnov D.A.

Russian Medical Academy of Continuous Professional Education;
Sklifosovsky Research Institute for Emergency Care

Yartsev P.A.

Sklifosovsky Research Institute for Emergency Care

SPIN RSCI: 4044-9661
Scopus AuthorID: 55970485700
ResearcherID: P-9151-2017
ORCID: 0000-0003-1270-5414

Levitsky V.D.

Sklifosovsky Research Institute for Emergency Care;
Penza Institute for Advanced Training of Doctors

Gulyaev A.A.

Sklifosofsky Research Center for Emergency Care;
Russian Medical Academy of Continuing Professional Education

Kislukhina E.V.

Sklifosovsky Research Institute for Emergency Care

Received:

22.12.2021

Accepted:

16.01.2022

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