Study on Laparoscopic Operation for Perforated Appendicitis
Study on Laparoscopic Operation for Perforated Appendicitis
The purpose of this study is to conduct a prospective observational study for the open
 approach and laparoscopic approach for perforated appendicitis. It is also designed to
 investigate if carbon dioxide pneumoperitoneum will have unwanted effect when treating
 perforated appendicitis with laparoscopic operation.
The role of laparoscopic appendectomy (LA) for perforated appendicitis is under
 investigation. According to the results of a previous retrospective study conducted in
 Far-Eastern Memorial Hospital comparing the clinical outcomes between perforated appendicitis
 patients treated by laparoscopic and open approach showed favored clinical outcomes for LA.
 Same as a few studies indicated that laparoscopic appendectomy is a safe and effective
 procedure for treating patients with perforated appendicitis in terms of hospital stay and
 wound complications. One the other hand, some authors still concern about the adverse effects
 of laparoscopy for ruptured appendicitis patients in terms of longer operation time and
 increased rates of postoperative abscess formation. We hypothesize that prolonged CO2
 pneumoperitoneum will produce transient mesenteric ischemic and reperfusion injury when CO2
 disinflation, and the free radicals and oxidative proteins provoked by reperfusion injury are
 responsible for the adverse reaction of LA. The objective of this prospective non-randomized
 controlled study is to examine the safety and efficacy of laparoscopic appendectomy and
 compare its outcome with that of the conventional approach for perforated appendicitis
 patients, with special emphasis on postoperative complication and oxidative stress resulted
 from pneumoperitoneum..
Inclusion Criteria:

 -  All patients admitted at the emergency station of our hospital expressing pain other
 than the right lower abdominal quadrant.

 -  The results of a clinical examination favored the diagnosis of perforated acute
 appendicitis, and the result of abdominal computed tomography revealed signs of acute
 appendicitis and intra-abdominal fluid accumulation.

 -  Patients were accepted to our study only if perforated appendicitis remained as the
 most likely diagnosis of their condition and if they were between 12 from 80 years old
 with informed consent.

 Exclusion Criteria:

 -  Age less than 12 years

 -  older than 80 years

 -  perforated appendicitis was not revealed by pathologic investigation

 -  diverticulitis being diagnosed during surgery

 -  pelvic inflammatory disease or other gynecologic disease found during laparoscopic
 examination or diagnosed before operation

 -  the patient declining to enroll in this study