SURGICAL TECHNIQUES IN COMPLICATED ACUTE APPENDICITIS: A LITERATURE REVIEW

• DOI: https://doi.org/10.22533/at.ed.51572122610063

• Palavras-chave: complicated appendicitis; appendectomy; laparoscopy; ileocecectomy; ostomy.

• Keywords: complicated appendicitis; appendectomy; laparoscopy; ileocecectomy; ostomy.

• Abstract:

  Introduction: Complicated acute appendicitis is a highly complex surgical condition associated with increased morbidity and the need for individualized intraoperative decisions, especially in the presence of perforation, abscess, or involvement of the cecum. Objective: To review the literature on the main surgical techniques and strategies used in the management of complicated acute appendicitis, with an emphasis on intraoperative decisions. Methodology: A narrative literature review was conducted in the PubMed/MEDLINE, SciELO, and LILACS databases, including original studies, systematic reviews, guidelines, and relevant clinical series on the surgical treatment of complicated appendicitis. Results: Laparoscopic appendectomy proved safe and effective in most cases, with a lower rate of wound infection and shorter hospital stay. However, situations such as compromised appendicular base, necrosis, or cecal friability often require extended resections, such as cecectomy or ileocecectomy. The decision between primary anastomosis and ostomy depends on hemodynamic stability, degree of contamination, and tissue quality. Copious peritoneal lavage did not demonstrate significant benefit, and the use of drains should be selective. Conclusion: The surgical management of complicated acute appendicitis should be individualized, prioritizing control of the source of infection and patient safety. The choice of technique depends primarily on intraoperative findings and the surgeon’s experience, and it is essential to avoid high-risk anastomoses in unfavorable scenarios.