The feasibility and safety of laparoscopic interval appendectomy for appendiceal abscess

Atsushi Kohyama, MD1, Takeshi Naito2, Hirohumi Ichikawa1, Kazuaki Hatsugai1, Masato Ohara1, Shigeru Ottomo1, Izuru Minemura1, Daisuke Takeyama1, Akefumi Sato1, Kentaro Shima1, Yusuke Gokon1, Iwao Kaneda1. 1Department of surgery, Ishinomaki red cross hospital, 2Department of Surgery, Tohoku University Graduate School of

Background: Although treatment for appendiceal abscess is primarily surgery, operative procedures are sometimes complicated and we often have great difficulties in dealing with postoperative complications. Recently clinical reports on interval appendectomy for appendiceal abscess are encountered, which comprises conservative therapy followed by elective appendectomy.

Purpose: The purpose of this study is to evaluate the feasibility and safety of laparoscopic interval appendectomy for appendiceal abscess.

Patients and Methods: Since April 2011 to September 2014, a total of 487 cases with appendicitis were operated in our institute. Among them, 16 patients with appendiceal abscess were treated with conservative treatment, followed by laparoscopic interval appendectomy. We retrospectively evaluated the feasibility and safety of this operation’s therapy.

Results: Ten of the patients were male and 6 of them were female, and their ages ranged from 9 to 86 (47.3 on average). Conservative treatment was successful in 15 of the 16 patients (93.8%) with a hospital stay of 9.4 days on average. Meropenem was administered to 11 patients. The other antibiotics were used as follows: tazobactam / piperacillin for 2 cases and cefmetazole for 2 other cases, levofloxacin for the remaining case. The conservative therapy failed in one case because recurrence of inflammation occurred prior to the operation. One patient required percutaneous abscess drainage under the ultrasonography guidance before the operation while other patietnts did not. The median interval period prior to surgery was 79 days. Of those 15 patients, 13 underwent elective laparoscopic interval appendectomy, and 2 underwent laparoscopic partial resection of the cecum. The median operation time was 138 minutes and mean estimated blood loss was 54 ml. The median postoperative hospital stay was 4 days. No complication occurred in any of the appendectomized patients. We used three ports for 15 of the patients, and we needed additional one port for traction in the remaining patient case. There were no conversions to open surgery.

Conclusion: Nonsurgical treatment for appendiceal abscess is a safe and effective therapy and laparoscopic interval appendectomy can be performed safely.

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