Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis...

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery
• Infectious Disease Management

Background:

• Laparoscopic appendectomy presents technical challenges, and perforated appendicitis with abscess often leads to significant morbidity.
• Initial percutaneous drainage offers a less invasive approach, allowing for elective interval appendectomy.
• The patient burden and outcome quality of this strategy require detailed evaluation.

Purpose of the Study:

• To audit the experience with initial percutaneous drainage followed by laparoscopic interval appendectomy in children with perforated appendicitis and abscess.
• To evaluate the medical burden and patient outcomes associated with this management strategy.
• To determine the need for a prospective trial comparing this approach with early surgical intervention.

Main Methods:

• Retrospective chart review of children treated between January 2000 and September 2006.
• Inclusion criteria: perforated appendicitis with a well-defined abscess.
• Analysis of patient demographics, treatment details, outcomes, complications, and costs.

Main Results:

• 52 children (mean age 9.0 years) underwent initial percutaneous drainage followed by interval appendectomy (mean 61.9 days later).
• Laparoscopic appendectomy was successful in 94.2% of cases with a short mean hospitalization (1.4 days).
• Complications included recurrent abscess (17.3%), need for re-drainage (11.5%), and 4 significant drain-related injuries; mean total charge was $40,414.02.

Conclusions:

• Initial percutaneous drainage followed by interval appendectomy is an effective treatment for pediatric appendiceal abscess.
• This approach involves significant complication risks and resource utilization.
• A prospective trial is warranted to compare this strategy against early operative intervention.