Tadashi Higuchi, Natsuya Katada, Ryohei Watanabe, Asako Takahashi, Sayaka Nagao, Emiko Takeshita, Toshiyuki Enomoto, Koji Asai, Yoichi Nakamura, Manabu Watanabe, Yoshihisa Saida, Shinya Kusachi. Department of Surgery, Toho university Ohashi Medical Center
INTRODUCTION: Surgery is often performed in the acute stages of an appendiceal abscess, but in such instances having a possibility of convert to an extended surgery or postoperative complications may be encountered. In order to avoid these problems, we performed laparoscopic interval appendectomy (LIA), a form of
laparoscopic appendectomy, with a interval of about 3 months after conservative treatment in abscess-forming appendicitis. The aim of study was to clarify the short term outcomes of LIA compared with emergency open appendectomy (EO) for the abscess-forming appendicitis.
METHOD AND PROCEDURES: A total of 711 patients underwent appendectomy from January 2003 to June 2015. Of those, 101 patients who had been admitted due to a periappendiceal abscess to Toho University Ohashi Medical Center, were enrolled into the study. These comprised 49 patients who underwent LIA and 33 patients who underwent EO. The outcomes of the two groups were retrospectively compared for patient characteristics, operative time, amount of bleeding, postoperative complication, length of hospital stay, medical expenditure.
RESULTS: The mean operative time required in EO group was 100.7 minutes and that in LIA group was 106.0 minutes (P=0.758). The mean amount of bleeding required in EO group was 223.3 ml and that in LIA group was 10.9 ml (P<0.0001).
Appendectomy for surgical procedure was completed without extended surgeries including ileocecal resection in 21 patients (63.6%)in the EO group and 49 patients (100%) in the LIA group (P=0.0005). The overall ratio of complications was significantly less in the LIA group (2.0%) compared with EO group (57.6%) (P<0.001). A mean duration of hospital stay in the EO group was of 14.4 days and that in the LIA group was 15.7 days (P=0.073). Althogh, a mean postoperative duration of the LIA group (4.3 days) was shorter compared with that in the EO group (13.6 days) , overall hospital durations were similar in both groups.
CONCLUSIONS: LIA was a safe and effective surgical procedure in appendectomy for abscess-forming appendicitis. LIA provided clinically beneficial advantages, including shorter postoperative hospital stay, lesser postoperative complication and amount of bleeding and no conversion to ileocecal resection over EO. LIA could be a standard treatment strategy as a minimally invasive surgery for appendicitis with abscess.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78912
Program Number: P066
Presentation Session: Poster (Non CME)
Presentation Type: Poster
