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Laparoscopic drainage of intraabdominal abscess after appendectomy: an alternative to laparotomy in cases not
Justin J Clark1, Sidney M Johnson
1Department of Surgery, University of Hawaii Surgical Residency Program, Honolulu, HI 96813, USA. jjclark_md@yahoo.com
Purpose:
Postoperative abscesses after appendectomy occur in 3% to 20% of cases and are more common in cases of perforated appendicitis. Smaller abscesses are often amenable to antibiotic therapy, but surgical drainage remains the mainstay of treatment for larger collections. Surgical options generally include percutaneous drainage and open laparotomy. Laparoscopic drainage of these abscesses has not been well characterized in the pediatric population.
Objective:
The aim of this study was to describe our experience with laparoscopic drainage of postappendectomy abscesses that were not amenable to percutaneous drainage.
Methods:
This study is a retrospective review of all pediatric patients who underwent laparoscopic appendectomy for acute appendicitis at a tertiary pediatric medical center during a 4-year period (2006-2009). The review focuses on patients who developed abscesses after appendectomy, were unable to undergo percutaneous drainage, and were treated with laparoscopic abscess drainage.
Results:
Twelve patients (7 male and 5 female) underwent laparoscopic drainage of postappendectomy abscesses. The mean age was 8.5 years old (range, 3-14 years). A clinical diagnosis of postoperative abscess was made when fevers, pain, and leukocytosis persisted despite broad-spectrum antibiotics. Computed tomography was performed in all patients. Abscesses ranged between 3 and 11 cm in size. The mean length of time between initial appendectomy and drainage procedure was 10 days. There were no complications specifically related to the laparoscopic drainage procedure. The mean length of the drainage procedure was 77 minutes (range, 30-196 minutes). The mean hospital length of stay after laparoscopic drainage was 6.5 days (range, 3-13 days) with patients maintained on intravenous antibiotics until afebrile and without leukocytosis.
Conclusion:
Laparoscopic drainage is a safe and effective alternative for intraabdominal abscesses that occur after laparoscopic appendectomy. We recommend it as an alternative to open laparotomy when percutaneous drainage is not an option.
Insights
Laparoscopic drainage is a safe and effective treatment for pediatric post-appendectomy abscesses when percutaneous drainage is not feasible. This minimally invasive approach offers a viable alternative to open surgery for managing these abdominal collections.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Abdominal Infections
Background:
- Postoperative abscesses following appendectomy occur in 3% to 20% of cases, particularly with perforated appendicitis.
- While smaller abscesses may respond to antibiotics, larger collections typically require surgical drainage.
- Established surgical options include percutaneous drainage and open laparotomy, but laparoscopic drainage in pediatric patients remains less characterized.
Purpose of the Study:
- To describe the experience with laparoscopic drainage of post-appendectomy abscesses in pediatric patients.
- To evaluate the safety and efficacy of laparoscopic drainage when percutaneous methods are not suitable.
Main Methods:
- A retrospective review was conducted on pediatric patients treated between 2006 and 2009 at a tertiary pediatric medical center.
- The study focused on patients who developed post-appendectomy abscesses, were unsuitable for percutaneous drainage, and underwent laparoscopic abscess drainage.
- Data collected included patient demographics, abscess characteristics, procedural details, and outcomes.
Main Results:
- Twelve pediatric patients (mean age 8.5 years) underwent laparoscopic drainage for post-appendectomy abscesses ranging from 3 to 11 cm.
- The average time from initial appendectomy to drainage was 10 days.
- No complications were associated with the laparoscopic procedure, with a mean operative time of 77 minutes and a mean hospital stay of 6.5 days.
Conclusions:
- Laparoscopic drainage is a safe and effective alternative for managing intra-abdominal abscesses after laparoscopic appendectomy in children.
- This minimally invasive technique is recommended when percutaneous drainage is not a viable option, offering an alternative to open laparotomy.
