Short-Term Efficacy of Laparoscopic Appendectomy for Overweight/Obese Patients with Acute Perforated or Gangrenous Appendicitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 GUANMin , ZHANGPing , LULi

Department of General Surgery, Traditional Chinese Medicine Hospital of Emei, Emei 614200, Sichuan Province, China;

Corresponding?author：

GUANMin, Email: 6695776@qq.com

Keywords：

Obesity; Acute appendicitis; Laparoscopic surgery; Postoperative mortality

DOI：

10.7507/1007-9424.20150352

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Objective To investigate the efficacy and safety of laparoscopic surgery for overweight/obese patients with acute perforated or gangrenous appendicitis. Methods From January 2007 to December 2014, patients with acute perforated or gangrenous appendicitis underwent laparoscopic (152 cases) or open (60 cases) appendectomy were collected, who were retrospectively classified into overweight/obese group (BMI≥25 kg/m², n=69) or normal weight group (BMI < 25 kg/m², n=143). Conversion rate, operation time, hospital stay, readmission, reoperation, and postoperative complications such as incision infection, abdominal abscess, and lung infection were analyzed. Results ①The rate of conversion to open surgery had no significant difference between the overweight/obese group and the normal weight group[4.2% (2/48) versus 6.7% (7/104), χ²=0.06, P > 0.05].②The operation time of laparoscopic surgery in the overweight/obese group was significantly shorter than that of the open surgery in the overweight/obese group[(41.6±11.7) min versus (63.1±23.3) min, P < 0.01], which had no significant difference between the laparoscopic surgery in the overweight/obese group and laparoscopic surgery in the normal weight group[(41.6±11.7) min versus (39.6±12.7) min, P > 0.05].③The total complications rate and incision infection rate of the laparoscopic surgery in the overweight/obese group were significantly lower than those of the open surgery in the overweight/obese group[total complications rate:16.7% (8/48) versus 52.4% (11/21), χ²=9.34, P < 0.01; incision infection rate:4.2% (2/48) versus 33.3% (7/21), χ²=8.54, P < 0.01]. Although the total complications rate of all the patients in the overweight/obese group was increased as compared with all the patients in the normal weight group[27.5% (19/69) versus 14.7% (21/143), χ²=5.02, P < 0.01], but which had no significant difference between the laparoscopic surgery in the overweight/obese group and laparoscopic surgery in the normal weight group[16.7% (8/48) versus 12.5% (13/104), χ²=0.45, P > 0.05].④The reoperation rate of all the patients performed laparoscopic surgery was significantly lower than that of all the patients performed open operation[1.3% (2/152) versus 10.0% (6/60), χ²=6.7, P < 0.01].⑤The abdominal abscess rate, lung infection rate, and hospital stay after discharge had no significant differences among all the patients (P > 0.05). Conclusion Laparoscopic appendectomy could be considered a safe technique for overweight/obese patients with acute perforated or gangrenous appendicitis, which could not increase the difficulty of laparoscopic surgery and the perioperative risk.

Citation： GUANMin, ZHANGPing, LULi. Short-Term Efficacy of Laparoscopic Appendectomy for Overweight/Obese Patients with Acute Perforated or Gangrenous Appendicitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(11): 1354-1358. doi: 10.7507/1007-9424.20150352 Copy

1.	?《中國居民營養與健康現狀》在京公布.營養學報, 2004, 26(6):417-420.
2.	幸天勇, 趙小波, 任亦星, 等.腹腔鏡闌尾切除術臨床價值再探討.中國普外基礎與臨床雜志, 2011, 18(9):982-986.
3.	Woodham BL, Cox MR, Eslick GD. Evidence to support the use of laparoscopic over open appendicectomy for obese individuals:a meta-analysis. Surg Endosc, 2012, 26(9):2566-2570.
4.	Krane MK, Allaix ME, Zoccali M, et al. Does morbid obesity change outcomes after laparoscopic surgery for inflammatory bowel disease? Review of 626 consecutive cases. J Am Coll Surg, 2013, 216(5):986-996.
5.	Ueda J, Ichimiya H, Okido M, et al. The impact of visceral fat accumulation on laparoscopy-assisted distal gastrectomy for early gastric cancer. J Laparoendosc Adv Surg Tech A, 2009, 19(2):157-162.
6.	陳建新, 黃昌明, 鄭朝輝, 等.肥胖對腹腔鏡輔助胃癌根治術臨床療效的影響.中華胃腸外科雜志, 2011, 14(10):781-784.
7.	Blanco FC, Sandler AD, Nadler EP. Increased incidence of perforated appendicitis in children with obesity. Clin Pediatr (Phila), 2012, 51(10):928-932.
8.	Garey CL, Laituri CA, Little DC, et al. Outcomes of perforated appendicitis in obese and nonobese children. J Pediatr Surg, 2011, 46(12):2346-2348.
9.	Masoomi H, Nguyen NT, Dolich MO, et al. Comparison of laparoscopic versus open appendectomy for acute nonperforated and perforated appendicitis in the obese population. Am J Surg, 2011, 202(6):733-739.
10.	顧虎, 李正東, 姜志寶, 等.肥胖患者急性穿孔性闌尾炎不同手術方式療效比較.河南職工醫學院學報, 2014, 26(6):658-660.
11.	Enochsson L, Hellberg A, Rudberg C, et al. Laparoscopic vs open appendectomy in overweight patients. Surg Endosc, 2001, 15(4):387-392.
12.	邵華, 孫威, 孫杰, 等.肥胖患者行腹腔鏡與開腹闌尾切除術療效的對比研究.中華普通外科雜志, 2012, 27(6):491-494.
13.	Davies DA, Yanchar NL. Appendicitis in the obese child. J Pediatr Surg, 2007, 42(5):857-861.
14.	Sadr Azodi O, Lindstr?m D, Adami J, et al. Impact of body mass index and tobacco smoking on outcome after open appendicectomy. Br J Surg, 2008, 95(6):751-757.
15.	Andersson RE. Short-term complications and long-term morbidity of laparoscopic and open appendicectomy in a National cohort. Br J Surg, 2014, 101(9):1135-1142.
16.	Nataraja RM, Teague WJ, Galea J, et al. Comparison of intraabdominal abscess formation after laparoscopic and open appendicectomies in children. J Pediatr Surg, 2012, 47(2):317-321.
17.	Hughes MJ, Harrison E, Paterson-Brown S. Post-operative antibiotics after appendectomy and post-operative abscess development:a retrospective analysis. Surg Infect (Larchmt), 2013, 14(1):56-61.
18.	Asarias JR, Schlussel AT, Cafasso DE, et al. Incidence of postoperative intraabdominal abscesses in open versus laparoscopic appendectomies. Surg Endosc, 2011, 25(8):2678-2683.
19.	St Peter SD, Adibe OO, Iqbal CW, et al. Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis:a prospective randomized trial. Ann Surg, 2012, 256(4):581-585.
20.	Wilson DG, Bond AK, Ladwa N, et al. Intra-abdominal collections following laparoscopic versus open appendicectomy:an experience of 516 consecutive cases at a district general hospital. Surg Endosc, 2013, 27(7):2351-2356.
21.	Markar SR, Blackburn S, Cobb R, et al. Laparoscopic versus open appendectomy for complicated and uncomplicated appendicitis in children. J Gastrointest Surg, 2012, 16(10):1993-2004.
22.	Nataraja RM, Loukogeorgakis SP, Sherwood WJ, et al. The incidence of intraabdominal abscess formation following laparoscopic appendicectomy in children:a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A, 2013, 23(9):795-802.
23.	Mason RJ, Moazzez A, Moroney JR, et al. Laparoscopic vs open appendectomy in obese patients:outcomes using the American College of Surgeons National Surgical Quality Improvement Program database. J Am Coll Surg, 2012, 215(1):88-100.
24.	Tan-Tam C, Yorke E, Wasdell M, et al. The benefits of laparoscopic appendectomies in obese patients. Am J Surg, 2012, 203(5):609-612.

1. ?《中國居民營養與健康現狀》在京公布.營養學報, 2004, 26(6):417-420.
2. 幸天勇, 趙小波, 任亦星, 等.腹腔鏡闌尾切除術臨床價值再探討.中國普外基礎與臨床雜志, 2011, 18(9):982-986.
3. Woodham BL, Cox MR, Eslick GD. Evidence to support the use of laparoscopic over open appendicectomy for obese individuals:a meta-analysis. Surg Endosc, 2012, 26(9):2566-2570.
4. Krane MK, Allaix ME, Zoccali M, et al. Does morbid obesity change outcomes after laparoscopic surgery for inflammatory bowel disease? Review of 626 consecutive cases. J Am Coll Surg, 2013, 216(5):986-996.
5. Ueda J, Ichimiya H, Okido M, et al. The impact of visceral fat accumulation on laparoscopy-assisted distal gastrectomy for early gastric cancer. J Laparoendosc Adv Surg Tech A, 2009, 19(2):157-162.
6. 陳建新, 黃昌明, 鄭朝輝, 等.肥胖對腹腔鏡輔助胃癌根治術臨床療效的影響.中華胃腸外科雜志, 2011, 14(10):781-784.
7. Blanco FC, Sandler AD, Nadler EP. Increased incidence of perforated appendicitis in children with obesity. Clin Pediatr (Phila), 2012, 51(10):928-932.
8. Garey CL, Laituri CA, Little DC, et al. Outcomes of perforated appendicitis in obese and nonobese children. J Pediatr Surg, 2011, 46(12):2346-2348.
9. Masoomi H, Nguyen NT, Dolich MO, et al. Comparison of laparoscopic versus open appendectomy for acute nonperforated and perforated appendicitis in the obese population. Am J Surg, 2011, 202(6):733-739.
10. 顧虎, 李正東, 姜志寶, 等.肥胖患者急性穿孔性闌尾炎不同手術方式療效比較.河南職工醫學院學報, 2014, 26(6):658-660.
11. Enochsson L, Hellberg A, Rudberg C, et al. Laparoscopic vs open appendectomy in overweight patients. Surg Endosc, 2001, 15(4):387-392.
12. 邵華, 孫威, 孫杰, 等.肥胖患者行腹腔鏡與開腹闌尾切除術療效的對比研究.中華普通外科雜志, 2012, 27(6):491-494.
13. Davies DA, Yanchar NL. Appendicitis in the obese child. J Pediatr Surg, 2007, 42(5):857-861.
14. Sadr Azodi O, Lindstr?m D, Adami J, et al. Impact of body mass index and tobacco smoking on outcome after open appendicectomy. Br J Surg, 2008, 95(6):751-757.
15. Andersson RE. Short-term complications and long-term morbidity of laparoscopic and open appendicectomy in a National cohort. Br J Surg, 2014, 101(9):1135-1142.
16. Nataraja RM, Teague WJ, Galea J, et al. Comparison of intraabdominal abscess formation after laparoscopic and open appendicectomies in children. J Pediatr Surg, 2012, 47(2):317-321.
17. Hughes MJ, Harrison E, Paterson-Brown S. Post-operative antibiotics after appendectomy and post-operative abscess development:a retrospective analysis. Surg Infect (Larchmt), 2013, 14(1):56-61.
18. Asarias JR, Schlussel AT, Cafasso DE, et al. Incidence of postoperative intraabdominal abscesses in open versus laparoscopic appendectomies. Surg Endosc, 2011, 25(8):2678-2683.
19. St Peter SD, Adibe OO, Iqbal CW, et al. Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis:a prospective randomized trial. Ann Surg, 2012, 256(4):581-585.
20. Wilson DG, Bond AK, Ladwa N, et al. Intra-abdominal collections following laparoscopic versus open appendicectomy:an experience of 516 consecutive cases at a district general hospital. Surg Endosc, 2013, 27(7):2351-2356.
21. Markar SR, Blackburn S, Cobb R, et al. Laparoscopic versus open appendectomy for complicated and uncomplicated appendicitis in children. J Gastrointest Surg, 2012, 16(10):1993-2004.
22. Nataraja RM, Loukogeorgakis SP, Sherwood WJ, et al. The incidence of intraabdominal abscess formation following laparoscopic appendicectomy in children:a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A, 2013, 23(9):795-802.
23. Mason RJ, Moazzez A, Moroney JR, et al. Laparoscopic vs open appendectomy in obese patients:outcomes using the American College of Surgeons National Surgical Quality Improvement Program database. J Am Coll Surg, 2012, 215(1):88-100.
24. Tan-Tam C, Yorke E, Wasdell M, et al. The benefits of laparoscopic appendectomies in obese patients. Am J Surg, 2012, 203(5):609-612.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Short-Term Efficacy of Laparoscopic Appendectomy for Overweight/Obese Patients with Acute Perforated or Gangrenous Appendicitis

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