Laparoscopic Surgery or Conservative Treatment for Appendiceal Abscess in Adults? A Randomized Controlled Trial. Issue 2 (August 2015)

• Record Type: Journal Article
• Authors: Mentula, Panu; Sammalkorpi, Henna; Leppäniemi, Ari
• Is Part Of: Annals of surgery. Volume 262:Issue 2(2015:Aug.)
• Publication Date: 2015-08
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000001200
• Languages: English
• ISSNs: 0003-4932

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objective:</title> <p>We hypothesized that immediate laparoscopic surgery for appendiceal abscess would result in faster recovery than conservative treatment.</p> </sec> <sec> <title>Background:</title> <p>On the basis of the retrospective studies, conservative management of appendiceal abscess is recommended as a first line treatment, but some controversy exists.</p> </sec> <sec> <title>Methods:</title> <p>Sixty adult patients diagnosed with appendiceal abscess were randomly assigned to either laparoscopic surgery (n = 30) or conservative treatment (n = 30). Hospital stay, recurrences, additional interventions, and complications within 60 days from randomization were recorded.</p> </sec> <sec> <title>Results:</title> <p>There was no difference in hospital stay: 4 days (interquartile range: 3–5 days) in the laparoscopy group versus 5 days (3–8) in the conservative group, <italic>P</italic> = 0.105. Patients in the laparoscopy group had 10% risk for bowel resection and 13% risk for incomplete appendectomy. There were significantly fewer patients with unplanned readmissions in the laparoscopy group: 1 (3%) versus 8 (27%), <italic>P</italic> = 0.026. Additional interventions were required in 2 (7%) patients in the laparoscopy group (percutaneous drainage) and in 9 (30%) patients in the conservative group (surgery), <italic>P</italic> = 0.042. Recurrent abscesses and failure to respond to conservative treatment were the main reasons for additional interventions. Open surgery was required in 3 (10%) patients in the laparoscopy group and in 4 (13%) patients in the conservative group. Postoperative complications occurred in 3 patients in laparoscopic group versus 2 patients in the conservative group. The rate of uneventful recovery was 90% in the laparoscopy group versus 50% in the conservative group, <italic>P</italic> = 0.002.</p> </sec> <sec> <title>Conclusions:</title> <p>Laparoscopic surgery in experienced hands is safe and feasible first-line treatment for appendiceal abscess. It is associated with fewer readmissions and fewer additional interventions than conservative treatment with comparable hospital stay.</p> </sec> </abstract>