Patel Parin Y, Akhani Milind K, Baria Bhavin, Rathod Ronak, Patel Ritesh
General Surgery, Health 1 Super Speciality Hospital, Ahmedabad, IND.
Surgical Gastroenterology, Hepatopancreatobiliary Surgery and Liver Transplantation, Health 1 Super Speciality Hospital, Ahmedabad, IND.
Cureus. 2025 Sep 13;17(9):e92225. doi: 10.7759/cureus.92225. eCollection 2025 Sep.
Perforated appendicitis is the most severe form of acute appendicitis and is associated with significant postoperative morbidity. Advances in laparoscopic surgery and perioperative care have transformed its management, yet the optimal surgical strategy remains debated. This systematic narrative review, conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and registered in PROSPERO (CRD420251125936), evaluated original studies on adult perforated appendicitis published between January 1, 2000 and June 1, 2025. Six studies encompassing 139,269 patients were included. Three compared laparoscopic and open appendectomy, while others examined prophylactic drainage, timing of drain removal, and immediate versus delayed surgery. Across studies, laparoscopic appendectomy was associated with shorter hospital stays (4-9.2 vs. 6-10.5 days) and lower overall complication rates (8.3-18.8% vs. 12.5-26.8%) compared with open surgery, though operative times were longer (114-121 vs. 94-106 minutes). Intra-abdominal abscess rates were variable: one early cohort reported similar rates (27.8% vs. 29.2%), the randomized trial showed higher risk with laparoscopy (11.7% vs. 4.5%), and a large database analysis showed lower risk (1.65% vs. 3.57%). Prophylactic drainage did not reduce abscess formation and was associated with increased complications and longer stay, whereas early drain removal following laparoscopy reduced morbidity (3.4% vs. 17.9%) without increasing abscess risk. Immediate surgery, although associated with lower drain utilization (14% vs. 42%), achieved fewer organ-space infections (14.0% vs. 23.8%) and shorter hospital stay (3.1 vs. 9.4 days) compared with delayed surgery. Overall, the evidence supports laparoscopic appendectomy as the preferred surgical approach for perforated appendicitis, with routine drainage discouraged and early removal favored when drains are placed. Future multicenter randomized studies are needed to refine perioperative strategies and establish standardized best practices in this high-risk subgroup.
穿孔性阑尾炎是急性阑尾炎最严重的形式，与显著的术后发病率相关。腹腔镜手术和围手术期护理的进展改变了其治疗方式，但最佳手术策略仍存在争议。本系统叙述性综述按照《系统评价和Meta分析的首选报告项目》（PRISMA）2020进行，并在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD420251125936）登记，评估了2000年1月1日至2025年6月1日期间发表的关于成人穿孔性阑尾炎的原始研究。纳入了6项研究，共涉及139,269例患者。3项研究比较了腹腔镜阑尾切除术和开腹阑尾切除术，其他研究则探讨了预防性引流、引流管拔除时机以及急诊手术与延期手术。在各项研究中，与开腹手术相比，腹腔镜阑尾切除术的住院时间更短（4 - 9.2天 vs. 6 - 10.5天），总体并发症发生率更低（8.3% - 18.8% vs. 12.5% - 26.8%），不过手术时间更长（114 - 121分钟 vs. 94 - 106分钟）。腹腔内脓肿发生率各不相同：一项早期队列研究报告发生率相似（27.8% vs. 29.2%），随机试验显示腹腔镜手术风险更高（11.7% vs. 4.5%），一项大型数据库分析显示风险更低（1.65% vs. 3.57%）。预防性引流并不能减少脓肿形成，且与并发症增加和住院时间延长相关，而腹腔镜手术后早期拔除引流管可降低发病率（3.4% vs. 17.9%），且不增加脓肿风险。与延期手术相比，急诊手术虽然引流管使用率较低（14% vs. 42%），但器官间隙感染更少（14.0% vs. 23.8%），住院时间更短（3.1天 vs. 9.4天）。总体而言，证据支持腹腔镜阑尾切除术作为穿孔性阑尾炎的首选手术方式，不鼓励常规引流，若放置引流管则倾向于早期拔除。未来需要多中心随机研究来优化围手术期策略，并在这个高风险亚组中建立标准化的最佳实践。
