Laparoscopic interval appendectomy-problems during non-surgical management-

Tomoaki Saito, Manabu Watanabe, Koji Asai, Hiroshi Matsukiyo, Tomotaka Ishi, Asako Takahashi, Takaharu Kiribayashi, Toshiyuki Enomoto, Yoshihisa Saida, Shinya Kusachi. Toho university, Ohashi medical center

Background:  Interval appendectomy is one of therapeutic strategies for Acute Appendicitis (AA) . But there are deteriorative and recurrent cases during first non-surgical management.

Aim: To clarify deteriorative and recurrent risk factors for laparoscopic interval appendectomy (LIA).

Patients and Methods: Patients underwent laparoscopic appendectomy for AA from January 2010 to May 2013. All patients were diagnosed by CT examination in our hospital. We analyzed deteriorative and recurrent risk factors during non-surgical treatment retrospectively.

Results: One-hundred-forty-four patients underwent laparoscopic appendectomy (LA). Eighty-one were man, and 63 were woman. Twelve patients (8.3%) deteriorated and underwent emergent laparoscopic appendectomy (ELA) during non-surgical management. Appendicolith rate was significantly higher in the patients who underwent ELA (p<0.01). One-hundred-thirty-two patients underwent LIA. Twenty-nine patients were recurrent before LIA. All recurrent patients could undergo non-surgical management again. Appendicolith rate and abscess formation rate were not significantly different between non-recurrent group and recurrent group. Time to median recurrent day was 111.5 (range: 11-986). Recurrent rate was significantly higher in the patients who tried to undergo 120 days after non-surgical treatment (p<0.01) .

Conclusion:  Appendicolith was deteriorative risk factor for first non-surgical management and optimal timing for LIA was within 4month after non-surgical management.

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