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Intraabdominal abscesses following laparoscopic and open appendectomies
E Tang1, A E Ortega, G J Anthone
1Department of Surgery, University of Southern California School of Medicine, Los Angeles 90033, USA.
Background:
The purpose of this review was to evaluate the incidence of postoperative intraabdominal abscess formation following laparoscopic and open appendectomies.
Methods:
The current study retrospectively examines appendectomies performed during the period from January 1993 to July 1994. Excluded were cases which were started laparoscopically but converted to open procedures. There were 1,287 cases identified; 597 were perforated (46%), 114 were gangrenous (9%), and 576 were acute (45%). These diagnoses represent intraoperative diagnoses.
Results:
Of the 576 appendectomies for acute appendicitis, 64 (11%) were performed laparoscopically. There were four intraabdominal abscesses (0.7%), all occurring after open procedures. Of the 114 appendectomies for gangrenous appendicitis, 16 (14%) were done laparoscopically. There were two postoperative abscesses (1.8%), one following an open and one following a laparoscopic procedure. There was no significant difference in abscess rate between laparoscopic and open appendectomies for either acute or gangrenous appendicitis. Of the 597 appendectomies for perforated appendicitis, 28 (5%) were done laparoscopically. There were 19 postoperative abscesses in the whole group, accounting for a 3.2% abscess rate. Sixteen abscesses occurred after open appendectomies and three occurred after laparoscopic appendectomies (2.9% vs 11%, P = 0.054). The preoperative diagnosis was incorrectly identified as acute appendicitis in 95 cases subsequently found to have perforated appendicitis; there was only 1 postoperative abscess in this group. There was no difference in postoperative stay in the open vs laparoscopic group (6.3 days vs 6.1 days).
Conclusions:
We found no significant difference in the rate of postoperative intraabdominal abscess formation between laparoscopic and open appendectomies in cases of acute or gangrenous appendicitis. However, laparoscopic appendectomy for perforated appendicitis was associated with an important trend toward a higher rate of postoperative intraabdominal abscess formation than open appendectomy. This observation calls for closer prospective scrutiny of laparoscopic appendectomy in the setting of perforated appendicitis.
Insights
Laparoscopic and open appendectomies showed similar rates of postoperative abscesses for acute and gangrenous appendicitis. However, perforated appendicitis cases suggest a higher abscess risk with laparoscopic procedures, warranting further investigation.
Area of Science:
- Surgical outcomes
- Minimally invasive surgery
- Gastrointestinal surgery
Background:
- Postoperative intraabdominal abscess formation is a potential complication of appendectomy.
- Comparing laparoscopic and open approaches is crucial for patient safety.
Purpose of the Study:
- To evaluate and compare the incidence of postoperative intraabdominal abscesses after laparoscopic versus open appendectomies.
- To analyze outcomes based on the severity of appendicitis (acute, gangrenous, perforated).
Main Methods:
- Retrospective review of 1,287 appendectomies (January 1993 - July 1994).
- Exclusion of cases converted from laparoscopic to open procedures.
- Categorization of appendicitis into acute (45%), gangrenous (9%), and perforated (46%) based on intraoperative diagnosis.
Main Results:
- No significant difference in abscess rates for acute or gangrenous appendicitis between laparoscopic and open approaches.
- For perforated appendicitis, laparoscopic procedures showed a trend toward higher abscess rates (11% vs. 2.9%, P=0.054).
- Postoperative stay was similar for both methods (6.3 days open vs. 6.1 days laparoscopic).
Conclusions:
- Laparoscopic and open appendectomies have comparable safety profiles for acute and gangrenous appendicitis regarding abscess formation.
- Laparoscopic appendectomy for perforated appendicitis may be associated with an increased risk of intraabdominal abscesses.
- Further prospective studies are recommended to scrutinize laparoscopic appendectomy outcomes in perforated appendicitis cases.