Abstract
The aim of this study was to investigate the effects of laparoscopic and open surgery on the development of postoperative surgical wound infection and wound healing between complicated appendicitis patients. Patients with complicated appendicitis were divided into those underwent laparoscopic and open surgical procedures according to the surgical method. Patients were followed up with regard to development of any postoperative wound infection, and medical, radiological, and surgical treatment methods and results were recorded. A total of 363 patients who underwent appendectomy were examined, of which 103 (28.4%) had complicated appendicitis. Postoperative wound infection rate in patients who underwent open surgery was 15.9%, while it was 6.8% in the laparoscopic surgery group. There was no statistically significant difference between the two groups in terms of infection development rates (P > .05). The rate of surgical drainage use and rehospitalisation was significantly higher in the group with wound infection than in the group without wound infection. (P < .05). We suggest that in terms of wound infection and wound healing, laparoscopic surgery should be the method of choice for patients with complicated appendicitis. In order to reduce the frequency of wound infection, drains should not be kept for a long time in patients undergoing appendectomy.
Keywords: complicated appendicitis, laparoscopic appendectomy, infection
Key Messages
Wound infection seen less frequently in complicated appendicitis patients who underwent laparoscopic surgery
Wound dehiscence seen less frequently in complicated appendicitis patients who underwent laparoscopic surgery
Surgical drain usage could increase the rate of wound infection in complicated appendicitis patients
Wound infection could increase the rate of rehospitalisation in complicated appendicitis patients
1. INTRODUCTION
Acute appendicitis (AA) is the most common disease requiring surgical intervention in patients who present with acute abdominal pain in general surgery clinics, and the incidence varies between 7% and 9%. It is most commonly seen between 10 and 30 years of age.1, 2 According to clinical and pathological findings, AA is divided into two subtypes as complicated and uncomplicated. It is classified as complicated appendicitis in the case of perforation of the appendix, gangrenous formation, and abscess development due to appendicitis. 2 Despite the use of clinical scoring systems and high‐sensitivity radiologic techniques such as ultrasound and computed tomography in the diagnosis, approximately 1 out of 4 (25%) of all appendicitis is presented as complicated appendicitis because of delay in admission or diagnosis. 3
Although conservative treatment has been recommended in the treatment of uncomplicated AA in recent years, 4 early surgical treatment is preferred in many of the uncomplicated appendicitis and almost all of the complicated appendicitis in order to reduce complications because of complicated appendicitis and postoperative mortality and morbidity. However, in some complicated appendicitis, especially in cases of abscess, appendectomy may be preferred after image‐guided abscess drainage and 8 to 12 weeks after successful conservative treatment upon administration of intravenous and oral antibiotics. 5 Laparoscopic appendectomy (LA) has been performed since the 1980s and it has been considered as the gold standard in the treatment of appendicitis since the 2000s. 6 LA is performed with three small ports that vary between 5 and 10 mm in diameter and can be displaced. Because it provides maximum triangulation, the appendix can be easily visualised and mobilised, allowing a safe appendectomy. 2 Advantages of laparoscopic surgery in the treatment of AA include the possibility of diagnostic laparoscopy for differential diagnosis, reducing the frequency of postoperative morbidity and wound infection, shorter hospital stay, better cosmetic results, less postoperative pain, and shorter postoperative recovery time and rapid return to daily life.6, 7 However, there are studies reporting that it is controversial in the treatment of complicated appendicitis because of its disadvantages such as long operation time and high incidence of postoperative intraabdominal infection and abscess.8, 9
Different rates of morbidity, and wound and surgical site infection may develop after laparoscopic and open appendectomy. It is known that postoperative infectious complications are more common in complicated appendicitis, and in many meta‐analysis studies, infectious complications have been reported to be less frequent after laparoscopic surgery compared to open surgery.6, 10 Although there are studies reporting that the incidence of intraabdominal abscess after LA is not higher than open surgery, in some previous studies the incidence of intraabdominal abscess after LA has been found to be higher; therefore, some surgeons directly prefer open surgery or conversion from laparoscopic surgery to open surgery in complicated appendicitis. 6
In this study, we aimed to investigate the effects of laparoscopic and open surgery on the development of postoperative wound infection and wound healing in patients operated for complicated appendicitis.
2. MATERIALS AND METHODS
This study was performed on patients who underwent laparoscopic and open appendectomy with the diagnosis of AA in our clinic between September 2017 and November 2019 and signed consent forms. Age, gender, body mass index (BMI), diabetes and smoking history, and American society of anesthesiologists (ASA) score were recorded in all patients who underwent appendectomy. According to the postoperative pathology results, patients with gangrenous appendicitis, perforated appendicitis, and patients who had intraabdominal abscess during operation were included in the complicated appendicitis group and all other patients were included in the uncomplicated appendicitis group. Patients with complicated appendicitis were divided into those underwent laparoscopic and open surgical procedures according to the surgical method. Prophylactic antibiotics were administered to all patients who underwent surgery for complicated appendicitis, and duration of postoperative iv antibiotic and outpatient antibiotic treatments was recorded. All surgeons who performed the operation had at least 5 years of surgical experience. Right paramedian incision was made in four patients who underwent open surgery while all the other patients had Mc Burney incision. Laparoscopic surgery was performed using three ports, one 10 mm and two 5 mm, and the appendix was removed with a removal bag in all patients. The appendix radix was ligated with purse string suture in open surgery and with endoloop in all patients who underwent laparoscopic surgery. Duration of operation and the use of drainage were recorded in all patients. All patients in both groups who underwent conversion to the open surgery for various reasons were excluded from the study.
Exclusion criteria include the patients under the age of 18, pregnant women, patients using antibiotics within the last week of surgery, patients receiving immunosuppressive therapy, those receiving regular steroids, patients with allergies, patients with major thalassemia, and patients with massive bleeding during surgery.
Patients were followed up with regard to development of any postoperative wound site and surgical site infection, and medical, radiological, and surgical treatment methods and results were recorded along with the information on whether the patients who developed infection were rehospitalised or not.
2.1. Statistical analysis
Mean, SD, median lowest, median highest, frequency, and ratio values were used in descriptive statistics of the data. Distribution of variables was measured using the Kolmogorov‐Smirnov test. In the analysis of quantitative independent data, Mann‐Whitney U test was used. The chi‐square test was used for the analysis of qualitative independent data, and the Fisher test was used when the chi‐square test conditions were not met. For statistical analysis, the SPSS 26.0 package program was used.
3. ETHICAL APPROVAL
This study was approved by the Ethics Committee of Alanya Alaaddin Keykubat University of Medical Sciences, and all of the patients were informed regarding the details of the study and they signed a consent form.
4. RESULTS
A total of 363 patients who underwent appendectomy in our clinic were included in the study. Postoperative wound infection was found in 25 patients (6.9%). Wound infection was seen in 14 (5.3%) and postoperative intraabdominal abscess was observed in 7 patients (2.7%) of the patients who underwent surgery for uncomplicated appendicitis. A total of 43 patients had gangrenous appendicitis (11.8%) and 57 patients had perforated appendicitis (15.7%). Three patients (0.9%) with pathology diagnosis of phlegmenous appendicitis and who had an abscess detected intraoperatively were included in the complicated appendicitis group. Of the 363 patients who underwent appendectomy, 103 (28.4%) had complicated appendicitis.
The sex distribution of 103 patients with complicated appendicitis was 39 (37.9%) female and 64 male (62.1%) with a mean age of 29 years. Fifty‐nine patients (57.3%) underwent LA and 44 patients (42.7%) underwent open appendectomy. Abscess was detected in 13 patients (12.6%) during the operation. Postoperative wound infection was seen in 11 (10.7%) and postoperative abdominal abscess developed in 6 (5.8%) patients who underwent operation because of complicated appendicitis. Demographic data and clinical characteristics of all patients with complicated appendicitis are presented in Table 1.
TABLE 1.
Demographic and clinical data of patients operated for complicated appendicitis
| Min−Max | Median | Mean ± SD/n% | ||||||
|---|---|---|---|---|---|---|---|---|
| Age | 18.0 | − | 64.0 | 29.0 | 32.1 | ± | 12.1 | |
| BMI | 19.0 | − | 29.0 | 24.0 | 23.8 | ± | 2.6 | |
| Gender | Female | 39 | 37.9% | |||||
| Male | 64 | 62.1% | ||||||
| ASA | I | 89 | 86.4% | |||||
| II | 7 | 6.8% | ||||||
| III | 7 | 6.8% | ||||||
| Duration of complaint (day) | 1.0 | − | 6.0 | 3.0 | 3.0 | ± | .9 | |
| Duration of surgery (min) | 20.0 | − | 65.0 | 40.0 | 39.3 | ± | 9.3 | |
| Length of hospital stay (day) | 1.0 | − | 22.0 | 3.0 | 2.8 | ± | 2.1 | |
| DM | (−) | 96 | 93.2% | |||||
| (+) | 7 | 6.8% | ||||||
| Comorbid disease | (−) | 96 | 93.2% | |||||
| (+) | 7 | 6.8% | ||||||
| Surgery | Open surgery | 44 | 42.7% | |||||
| Laparoscopic surgery | 59 | 57.3% | ||||||
| Pathology | Phlegmenous | 3 | 2.9% | |||||
| Gangrenous | 43 | 41.7% | ||||||
| Perforated | 57 | 55.3% | ||||||
| Surgical drainage | (−) | 83 | 80.6% | |||||
| (+) | 20 | 19.4% | ||||||
| Wound infection | (−) | 92 | 89.3% | |||||
| (+) | 11 | 10.7% | ||||||
| IV antibiotics (day) | 1.0 | − | 22.0 | 3.0 | 2.8 | ± | 2.1 | |
| Oral antibiotics (day) | 5.0 | − | 7.0 | 5.0 | 5.9 | ± | 1.0 | |
| Peroperative abscess | (−) | 90 | 87.4% | |||||
| (+) | 13 | 12.6% | ||||||
| Rehospitalisation | (−) | 95 | 92.2% | |||||
| (+) | 8 | 7.8% | ||||||
| Postoperative abscess | (−) | 97 | 94.2% | |||||
| (+) | 6 | 5.8% | ||||||
Abbreviations: ASA, American society of anesthesiologists; BMI, body mass index; DM, diabetes mellitus.
There was no statistically significant difference between the ages of the patients who underwent open surgery and laparoscopy (P > .05). The rate of male patients was significantly higher in the open surgery group than in the laparoscopy group (P < .05). BMI value, presence of DM and comorbid disease, ASA distribution, duration of complaint, rate of abscess detection during surgical operation, duration of operation, length of hospital stay, duration of IV and postoperative oral antibiotic administration, surgical drainage use, and rehospitalisation rate did not differ significantly (P > .05). Postoperative wound infection was seen in 7 patients (15.9%) who underwent open surgery and in 4 patients (6.8%) who underwent laparoscopic surgery. There was no statistically significant difference between the two groups (P > .05). Postoperative intraabdominal abscess was detected in 4 patients (9.1%) who underwent open surgery and in 2 patients (3.4%) who underwent laparoscopic surgery; no statistically significant difference was observed (P > .05). Table 2 presents the data of patients who underwent laparoscopic and open surgery.
TABLE 2.
Data of patients undergoing laparoscopic and open surgery with the diagnosis of complicated appendicitis
| Open surgery | Laparoscopic surgery | P | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Ort. ± s.s./n% | Medyan | Ort. ± s.s./n% | Medyan | ||||||||
| Age | 31.3 | ± | 13.6 | 26.0 | 32.7 | ± | 10.9 | 31.0 | .184 | m | |
| Gender | Female | 11 | 25.0% | 28 | 47.5% | .020 | X 2 | ||||
| Male | 33 | 75.0% | 31 | 52.5% | |||||||
| BMI | 24.0 | ± | 2.6 | 24.0 | 23.7 | ± | 2.6 | 24.0 | .535 | m | |
| ASA | I | 39 | 88.6% | 50 | 84.7% | .735 | X 2 | ||||
| II | 2 | 4.5% | 5 | 8.5% | |||||||
| III | 3 | 6.8% | 4 | 6.8% | |||||||
| Duration of complaint (day) | 2.9 | ± | 0.9 | 3.0 | 3.1 | ± | 0.8 | 3.0 | .156 | m | |
| Duration of surgery (min) | 38.4 | ± | 9.0 | 35.0 | 39.9 | ± | 9.5 | 40.0 | .269 | m | |
| Length of hospital stay (day) | 3.1 | ± | 3.1 | 3.0 | 2.6 | ± | 0.8 | 3.0 | .706 | m | |
| DM | (−) | 40 | 90.9% | 56 | 94.9% | .424 | X 2 | ||||
| (+) | 4 | 9.1% | 3 | 5.1% | |||||||
| Comorbid disease | (−) | 39 | 88.6% | 57 | 96.6% | .112 | X 2 | ||||
| (+) | 5 | 11.4% | 2 | 3.4% | |||||||
| Surgical drainage | (−) | 33 | 75.0% | 50 | 84.7% | .216 | X 2 | ||||
| (+) | 11 | 25.0% | 9 | 15.3% | |||||||
| Wound infection | (−) | 37 | 84.1% | 55 | 93.2% | .138 | X 2 | ||||
| (+) | 7 | 15.9% | 4 | 6.8% | |||||||
| IV antibiotics (day) | 3.1 | ± | 3.1 | 3.0 | 2.6 | ± | 0.8 | 3.0 | .706 | m | |
| Oral antibiotics (day) | 5.7 | ± | 1.0 | 5.0 | 6.1 | ± | 1.0 | 7.0 | .105 | m | |
| Peroperative abscess | (−) | 37 | 84.1% | 53 | 89.8% | .055 | X 2 | ||||
| (+) | 7 | 15.9% | 6 | 10.2% | |||||||
| Rehospitalisation | (−) | 38 | 86.4% | 57 | 96.6% | .222 | X 2 | ||||
| (+) | 6 | 13.6% | 2 | 3.4% | |||||||
| Postoperative abscess | (−) | 40 | 90.9% | 57 | 96.6% | .138 | X 2 | ||||
| (+) | 4 | 9.1% | 2 | 3.4% | |||||||
Note: m indicates Mann‐Whitney U test; and X 2 indicates chi‐square test (Fischer test). Values in bold indicate gender significant (correct).
In the study of patients with and without postoperative wound infection, age, gender BMI, ASA distribution, DM and comorbid disease rates, duration of complaint, duration of surgical operation, length of hospital stay, duration of postoperative antibiotic administration, and postoperative intraabdominal abscess development rates did not differ significantly (P > .05). The rate of surgical drainage use was significantly higher in the group with wound infection compared with the group without wound infection (P < .05). Furthermore, the rate of rehospitalisation was significantly higher in the group with wound infection than in the group without wound infection (P < .05). Data for patients with postoperative wound infection are presented in Table 3 and Figure 1.
TABLE 3.
Data of patients who underwent surgical operation for complicated appendicitis and who did not have wound infection
| Wound infection (−) | Wound infection (+) | P | ||||||||||
| Mean. ± SD/n% | Median | Mean. ± SD/n% | Median | |||||||||
| Age | 32.1 | ± | 12.8 | 29.0 | 34.0 | ± | 10.5 | 30.0 | .190 | m | ||
| BMI | 23.9 | ± | 2.7 | 24.0 | 25.1 | ± | 2.6 | 25.0 | .188 | m | ||
| Gender | Female | 33 | 35.9% | 6 | 54.5% | .227 | X 2 | |||||
| Male | 59 | 64.1% | 5 | 45.5% | ||||||||
| ASA | I | 79 | 85.9% | 10 | 90.9% | .996 | X 2 | |||||
| II | 7 | 7.6% | 0 | 0.0% | ||||||||
| III | 6 | 6.5% | 1 | 9.1% | ||||||||
| Duration of complaint (day) | 2.0 | ± | 0.9 | 2.0 | 2.4 | ± | 0.8 | 2.0 | .876 | m | ||
| Duration of surgery (min) | 36.2 | ± | 9.0 | 35.0 | 35.4 | ± | 8.5 | 35.0 | .879 | m | ||
| Length of hospital stay (day) | 1.7 | ± | 1.4 | 1.0 | 2.1 | ± | 1.2 | 2.0 | .320 | m | ||
| DM | (−) | 87 | 94.6% | 9 | 81.8% | .162 | X 2 | |||||
| (+) | 5 | 5.4% | 2 | 18.2% | ||||||||
| Comorbid disease | (−) | 86 | 93.5% | 10 | 90.9% | .558 | X 2 | |||||
| (+) | 6 | 6.5% | 1 | 9.1% | ||||||||
| Surgery | Open | 37 | 40.2% | 7 | 63.6% | .138 | X 2 | |||||
| Laparoscopic | 55 | 59.8% | 4 | 36.4% | ||||||||
| Surgical drainage | (−) | 77 | 83.7% | 6 | 54.5% | .021 | X 2 | |||||
| (+) | 15 | 16.3% | 5 | 45.5% | ||||||||
| IV antibiotics (day) | 1.5 | ± | 1.5 | 1.0 | 2.0 | ± | 1.2 | 2.0 | .320 | m | ||
| Oral antibiotics (day) | 4.5 | ± | 2.1 | 5.0 | 5.1 | ± | 1.8 | 5.0 | .990 | m | ||
| Peroperative abscess | (−) | 81 | 88.0% | 9 | 81.8% | .627 | X 2 | |||||
| (+) | 11 | 12.0% | 2 | 18.2% | ||||||||
| Rehospitalisation | (−) | 88 | 95.7% | 7 | 63.6% | .000 | X 2 | |||||
| (+) | 4 | 4.3% | 4 | 36.4% | ||||||||
| Postoperative abscess | (−) | 88 | 95.7% | 9 | 81.8% | .123 | X 2 | |||||
| (+) | 4 | 4.3% | 2 | 18.2% | ||||||||
Note: m indicates Mann‐Whitney U test; X 2 indicates chi‐square test (Fischer test). Values in bold indicate surgical drainage and rehospitalization significant (correct).
Abbreviations: ASA, American society of anesthesiologists; BMI, body mass index; DM, diabetes mellitus.
FIGURE 1.
Rate of rehospitalisation was significantly higher in patients with wound infection than those without wound infection, and the use of surgical drainage was found to be significantly higher in the group with wound infection
5. DISCUSSION
Complicated appendicitis due to delay in diagnosis and treatment have been reported more frequently in very young, elderly individuals or in those who have comorbid diseases such as diabetes, coronary artery disease, hypercholesterolemia, and smoking habit.2, 11 It has been reported that various clinical manifestations of age‐related appendicitis can be seen, physical examination findings may vary, different individual responses to inflammation depending on age may occur, and there might be a predisposition to the development of complications such as vasculitis, microvascular transmural ischaemia, gangrene, perforation or abscess. 11 Although different rates have been reported by several studies, it is known that length of hospital stay, infectious rates, and total complication rates in complicated appendicitis are significantly higher than uncomplicated appendicitis. In a recent meta‐analysis study of 3108 patients, 97% of uncomplicated appendicitis, 83% of perforated appendicitis, and 90% of gangrenous appendicitis underwent laparoscopic surgery. In 30‐day follow‐up of these cases, infectious complication rate was 5% for uncomplicated appendicitis, 20% for perforated appendicitis, and 16% for gangrenous appendicitis. Intraabdominal abscess development rates were 1%, 7%, and 6%, respectively. 12 In our study, 363 patients were operated with a pre‐diagnosis of appendicitis, 260 patients had uncomplicated appendicitis, and 103 patients had complicated appendicitis. The rate of wound infection was 5.3% in uncomplicated appendicitis, and the rate of postoperative intraabdominal abscess development was 2.7%. These rates were 10.7% and 5.8%, respectively, in patients operated for complicated appendicitis.
LA, first described by Semm in 1983 for the treatment of AA, 13 has many advantages over open surgery. One of these advantages is that the risk of wound infection after LA is lower than that in open surgery. In a recent meta‐analysis study of 7,462 patients who underwent LA due to the diagnosis of AA, the incidence of wound infection was reported to be 3.29% while it was 7.78% in patients undergoing open appendectomy. 10 The risk of developing wound infection was also significantly lower in patients who underwent LA for complicated appendicitis. In a recent meta‐analysis study of 6,428 patients operated for complicated appendicitis, the data of 3,254 patients who underwent LA and 3,174 patients who underwent open appendectomy were examined, and it was found that wound infection rates were significantly lower in patients who were treated with LA compared with patients who underwent open surgery. In this study, wound infection rate was 4.7% in patients undergoing LA and 12.8% in patients undergoing open surgery. In randomised studies, these rates were reported as 12.3% and 23.2%, respectively. 6 One of the most important reasons for the less occurrence of infection in complicated appendicitis compared with open surgery is that the incision is small and the ports used in laparascopy prevent the contamination of the appendix and the appendix is removed from the abdomen with a specimen extraction bag. 14 As another factor, it has been reported that the preservation of immune functions in laparoscopic surgery is more effective than open surgery. 15 In our study, 103 patients were operated for complicated appendicitis. Postoperative wound infection developed in seven patients (15.9%) who underwent open surgery and in four patients (6.8%) who underwent laparoscopic surgery. There was no statistically significant difference between the two groups.
Some risk factors are associated with more frequent infectious complications in complicated appendicitis. The most important of these risk factors is age. Complicated appendicitis is seen more frequently in the elderly compared with the younger individuals, thus increasing the frequency of complications. Lower physiological reserve, poor nutritional status, and more frequent comorbid diseases in elderly patients with complicated appendicitis increase susceptibility to infectious complications and mortality risk. 16 In one study, it was reported that the risk of complications was in patients who were operated for AA increased from the age of 38.5 years, 17 and in another study complication risk was higher in patients aged 39 and older. 18 However, there was no significant difference in postoperative complications with regard to age. 19 In another study of 372 patients operated with the diagnosis of acute appendicitis, it was reported that patient age, leucocyte and CRP level, duration of the surgical operation, presence of comorbid disease, ASA score, and length of hospital stay were risk factors for the development of infectious complications in patients with complicated appendicitis. It has been reported that infectious complications develop more frequently in patients with ASA score 2 and above, increase in the frequency of complications was associated with prolonged duration of surgical operation and hospitalisation, and shortening the length of hospital stay after laparoscopic surgery is therefore an advantage.17, 19, 20 Furthermore, although more common occurrence of comorbid diseases such as pulmonary and cardiac problems leads surgeons to prefer open surgery, it was reported that laparoscopic surgery should be preferred in elderly patients with complicated appendicitis. 19 There are studies indicating that duration of surgical operation in laparoscopic appendectomies is longer than open surgery, and this is a disadvantage for LA. However, there are also studies reporting that there is no difference in operation time in open and laparoscopic surgery. It has also been suggested that operation time can be reduced by applying new surgical techniques and gaining surgical practice. 6 In our study, no statistically significant difference was found in patients with and without wound infection in terms of the age, gender, BMI, ASA distribution, DM and comorbid disease rates, duration of surgery, and the detection of abscess during operation. Therefore, the patient group in our study can be considered as a homogenous group. However, the use of surgical drainage was found to be significantly higher in the group with wound infection than in the group without wound infection.
One of the most common infectious complications in patients operated for complicated appendicitis is intraabdominal abscess formation. Besides, the studies reporting that intraabdominal abscess develops more frequently in laparoscopic surgery due to bacterial contamination induced by pneumoperitoneum and operative techniques such as duration of antibiotic usage and wide application of lavage,21, 22 there are studies suggesting that pneumoperitoneum does not cause bacterial contamination 23 and that there is no difference between LA and open surgery with regard to abscess development. 24 In addition, the Cochran study published in 2010 8 reported that the development of intraabdominal abscess was significantly more frequent after laparoscopic appendectomies; however, many studies and meta‐analyses reported no significant differences in the development of intraabdominal abscesses. In our study, postoperative intraabdominal abscess was seen in 4 patients (9.1%) who underwent open surgery and in 2 patients (3.4%) who underwent laparoscopic surgery. There was no statistically significant difference between the two groups.
The duration of antibiotic use in complicated appendicitis is known to have an impact on postoperative infectious complications. In a study on complicated appendicitis, 31.5% of 181 patients diagnosed with gangrenous appendicitis were given antibiotics for less than 24 hours, and 68.5% were treated with more than 24 hours of antibiotic therapy. Although infectious complications were found to be significantly higher in patients receiving antibiotics longer than 24 hours, there was no statistically significant difference. Even though long‐term antibiotic administration does not reduce infectious complications, it increases the length of hospital stay approximately twofold. 25 In another study, it was reported that administration of two doses of antibiotics in complicated appendicitis decreased the length of hospital stay by 50% without causing an increase in complication rate. 26 In our study, the duration of postoperative antibiotic use and length of hospital stay in patients with and without wound infection were investigated. There was no significant difference between postoperative antibiotic use and the length of hospital stay, but the rate of rehospitalisation was significantly higher in patients with wound infection compared with those without wound infection. In our study, one patient who developed wound infection following LA had a wound dehiscence at the 10 mm port entrance site and was hospitalised for 14 days for treatment. Three patients who developed postoperative wound infection following open surgery had wound dehiscence and were hospitalised for 20 to 28 days.
In conclusion, in our study, postoperative wound infection was seen less frequently in complicated appendicitis patients who underwent LA; however, there was no statistically significant difference compared with open surgery, and the complication of wound dehiscence was significantly less frequent in the laparoscopic patient group. It was found that the use of surgical drainage could increase the rate of wound infection and this complication significantly increased hospitalisation rates. For these reasons, in terms of wound infection and wound healing, laparoscopic surgery should be the method of choice for patients with complicated appendicitis who are at high risk of infectious complications and drains should not be kept for a long time in patients undergoing appendectomy. In order to reduce the frequency of wound infection, we believe that maximum care should be taken in all patients who undergo both open and laparoscopic surgeries, especially in terms of decreasing morbidity, length of hospital stay, treatment costs, and labour loss.
ACKNOWLEDGEMENTS
We thank to all our patients who participated to this study.
Conflict of Interest
The authors declare no conflicts of interest.
Güler Y, Karabulut Z, Çaliş H, Şengül S. Comparison of laparoscopic and open appendectomy on wound infection and healing in complicated appendicitis. Int Wound J. 2020;17:957–965. 10.1111/iwj.13347
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