Skip to main content
SpringerLink
Log in

Surgical Outcomes of Interval Laparoscopic Appendectomy for Appendiceal Abscess and Predictors of Conversion to Open Surgery

  • Original Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

The present study was performed to clarify the benefits of interval laparoscopic appendectomy (ILA) for appendiceal abscess by comparison with emergency laparoscopic appendectomy (ELA), and to identify any risk factors associated with conversion to open ILA. Among 903 adult patients with acute appendicitis, we conducted a retrospective analysis of 58 patients with appendiceal abscess who had undergone either ILA after conservative treatment (ILA group; n = 44) or ELA (ELA group; n = 14). The two groups were compared with regard to surgical outcomes, and the risk factors for conversion to open surgery were also estimated in the ILA group. ILA was superior to ELA in terms of blood loss (median 5 ml vs. 50 ml; p < 0.01), rate of conversion to open surgery (16% vs. 43%; p < 0.05), postoperative hospital stay (median 4 days vs. 8 days; p < 0.01), and morbidity (7% vs. 36%; p < 0.01). In the ILA group, analysis of clinical factors showed that a higher C-reactive protein level, escalation of antibiotic treatment, and longer hospitalization during conservative treatment were significantly associated with conversion. Interval laparoscopic appendectomy following conservative treatment is less invasive and has lower morbidity. However, the presence of severe inflammation at the time of conservative treatment substantially affects conversion from laparoscopic to open surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kim JY, Kim JW, Park JH, Kim BC, Yoon SN (2019) Early versus late surgical management for complicated appendicitis in adults: a multicenter propensity score matching study. Ann Surg Treat Res 97(2):103–111. https://doi.org/10.4174/astr.2019.97.2.103

    Article  PubMed  PubMed Central  Google Scholar 

  2. Olsen J, Skovdal J, Qvist N, Bisgaard T (2014) Treatment of appendiceal mass--a qualitative systematic review. Dan Med J 61:A4881

    PubMed  Google Scholar 

  3. Ahmed A, Feroz SH, Dominic JL, Muralidharan A, Thirunavukarasu P (2020) Is emergency appendicectomy better than elective appendicectomy for the treatment of appendiceal phlegmon?: A review. Cureus. 12:e12045. https://doi.org/10.7759/cureus.12045

    Article  PubMed  PubMed Central  Google Scholar 

  4. So JB, Chiong EC, Chiong E, Cheah WK, Lomanto D, Goh P, Kum CK (2002) Laparoscopic appendectomy for perforated appendicitis. World J Surg 26:1485–1488. https://doi.org/10.1007/s00268-002-6457-7

    Article  PubMed  Google Scholar 

  5. Quah GS, Eslick GD, Cox MR (2019) Laparoscopic appendicectomy is superior to open surgery for complicated appendicitis. Surg Endosc 33(7):2072–2082. https://doi.org/10.1007/s00464-019-06746-6

    Article  PubMed  Google Scholar 

  6. Horn CB, Coleoglou Centeno AA, Guerra JJ, Mazuski JE, Bochicchio GV, Turnbull IR (2018) Drain failure in intra-abdominal abscesses associated with appendicitis. Surg Infect 19:321–325. https://doi.org/10.1089/sur.2017.224

    Article  Google Scholar 

  7. Mentula P, Sammalkorpi H, Leppäniemi A (2015) Laparoscopic surgery or conservative treatment for appendiceal abscess in adults? A randomized controlled trial. Ann Surg 262:237–242. https://doi.org/10.1097/SLA.0000000000001200

    Article  PubMed  Google Scholar 

  8. Wright GP, Mater ME, Carroll JT, Choy JS, Chung MH (2015) Is there truly an oncologic indication for interval appendectomy? Am J Surg 209:442–446. https://doi.org/10.1016/j.amjsurg.2014.09.020

    Article  PubMed  Google Scholar 

  9. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2

    Article  PubMed  Google Scholar 

  10. Garst GC, Moore EE, Banerjee MN, Leopold DK, Burlew CC, Bensard DD, Biffl WL, Barnett CC, Johnson JL, Sauaia A (2013) Acute appendicitis: a disease severity score for the acute care surgeon. J Trauma Acute Care Surg 74(1):32–36. https://doi.org/10.1097/TA.0b013e318278934a

    Article  PubMed  Google Scholar 

  11. Sugiura K, Suzuki K, Umeyama T, Omagari K, Hashimoto T, Tamura A (2020) Cost-effectiveness analysis of initial nonoperative management versus emergency laparoscopic appendectomy for acute complicated appendicitis. BMC Health Serv Res 20:1019. https://doi.org/10.1186/s12913-020-05839-6

    Article  PubMed  PubMed Central  Google Scholar 

  12. Elkbuli A, Diaz B, Polcz V, Hai S, McKenney M, Boneva D (2018) Operative versus non-operative therapy for acute phlegmon of the appendix: is it safer? A case report and review of the literature. Int J Surg Case Rep 50:75–79. https://doi.org/10.1016/j.ijscr.2018.07.031

    Article  PubMed  PubMed Central  Google Scholar 

  13. Samuel M, Hosie G, Holmes KJ (2002) Prospective evaluation of nonsurgical versus surgical management of appendiceal mass. Pediatr Surg 37:882–886. https://doi.org/10.1053/jpsu.2002.32895

    Article  CAS  Google Scholar 

  14. Bahram MA (2011) Evaluation of early surgical management of complicated appendicitis by appendicular mass. Int J Surg 9:101–103. https://doi.org/10.1016/j.ijsu.2010.10.006

    Article  CAS  PubMed  Google Scholar 

  15. Guller U, Hervey S, Purves H, Muhlbaier LH, Peterson ED, Eubanks S, Pietrobon R (2004) Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database. Ann Surg 239:43–52. https://doi.org/10.1097/01.sla.0000103071.35986.c1

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kleif J, Thygesen LC, Gögenur I (2021) Moving from an era of open appendectomy to an era of laparoscopic appendectomy: a nationwide cohort study of adult patients undergoing surgery for appendicitis. Scand J Surg 9:1457496921992615. https://doi.org/10.1177/1457496921992615

    Article  Google Scholar 

  17. Abe T, Nagaie T, Miyazaki M, Ochi M, Fukuya T, Kajiyama K (2013) Risk factors of converting to laparotomy in laparoscopic appendectomy for acute appendicitis. Clin Exp Gastroenterol 6:109–114. https://doi.org/10.2147/CEG.S41571

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The author would like to thank David Douglas (douglas@gol.com) for the English language review.

Author information

Authors and Affiliations

  1. Department of General Surgery, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo, 177-8521, Japan

    Yuuki Sekine, Hiroyuki Sugo, Shozo Miyano, Ikuo Watanobe, Michio Machida & Kuniaki Kojima

Authors
  1. Yuuki Sekine
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroyuki Sugo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shozo Miyano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ikuo Watanobe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michio Machida
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kuniaki Kojima
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroyuki Sugo.

Ethics declarations

The study was reviewed and approved by the Institutional Review Board of Juntendo University Nerima Hospital (Tokyo, Japan; approval number: 17-46), and the requirement for informed consent was waived because of the retrospective nature of the study and the use of anonymized data.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sekine, Y., Sugo, H., Miyano, S. et al. Surgical Outcomes of Interval Laparoscopic Appendectomy for Appendiceal Abscess and Predictors of Conversion to Open Surgery. Indian J Surg 83 (Suppl 3), 755–760 (2021). https://doi.org/10.1007/s12262-021-02819-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-021-02819-w

Keywords

Search

Navigation