Comparison of the Outcomes of Laparoscopic and Open Approaches in the Treatment of Periappendiceal Abscess Diagnosed by Radiologic Investigation

Abstract

BACKGROUND: Although laparoscopic appendectomy (LA) has been performed widely, the role of LA for complicated appendicitis remains controversial, and its role for periappendiceal abscess (PA) remains undefined. This study compared the clinical outcomes of LA and open appendectomy (OA) for PA diagnosed by radiologic investigation. PATIENTS AND METHODS: We conducted a retrospective review of 84 patients who underwent surgery for PA diagnosed by radiologic investigation between 2010 and 2013. Twenty-five patients underwent LA, and the remaining patients underwent OA. Patient characteristics, operative outcomes, and surgical complications were compared between the two groups. RESULTS: Three patients required conversion from LA to OA (12%). There were no significant differences in the overall complication (28% versus 25.4%; P=.8), wound infection (15.3% versus 4%; P=.27), stump leakage (4% versus 1.7%; P=.51), and postoperative ileus (4% versus 8.5%; P=.66) rates between the groups. The incidence of intraabdominal abscess (IAA) was significantly higher in the LA group (20% versus 3.4%; P=.02). In multivariate analysis, the risk factors for IAA were duration of drainage (P=.04) and type of operation (P=.006). The major complications rate was 2.4% in the total cohort, and the rate was significantly higher in the LA group (8% versus 0%; P=.02). CONCLUSIONS: For patients with PA, the rates of overall complications, wound infection, stump leakage, and postoperative ileus were similar for both procedures. However, LA resulted in a significantly higher incidence of IAA and major complications than OA.