OBJECTIVE: Given the perceived technical demands of laparoscopic appendectomy and the expected postoperative morbidity in patients with a well-defined abscess, initial percutaneous drainage has become an attractive option in this patient population. This strategy allows for a laparoscopic appendectomy to be performed in an elective manner at the convenience of the surgeon. However, the medical burden on the patient and on the quality of patient outcomes has not been described in the literature. Therefore, we audited our experience with initial percutaneous drainage followed by laparoscopic interval appendectomy to evaluate the need for a prospective trial. METHODS: After institutional review board approval, a retrospective chart review was performed on all children who presented with perforated appendicitis and a well-defined abscess and were treated by initial percutaneous aspiration/drainage followed by interval appendectomy between January 2000 and September 2006. Continuous variables are listed with standard deviation. RESULTS: There were 52 patients with a mean age of 9.0 +/- 3.9 years and weight of 34.4 +/- 18.8 kg. The mean duration of symptoms at presentation was 8.4 +/- 7.6 days. Percutaneous aspiration only was performed in 2 patients. The mean volume of fluid on initial aspiration/drain placement was 76.3 +/- 81.1 mL. The mean time to appendectomy was 61.9 +/- 25.2 days. The laparoscopic approach was used in 49 patients (94.2%), of which one was converted to an open operation. The mean length of hospitalization after interval appendectomy was 1.4 +/- 1.4 days. A recurrent abscess developed in 17.3% of the patients. Six patients (11.5%) required another drainage procedure. The mean total charge to the patients was $40,414.02. There were 4 significant drain complications (ileal perforation, colon perforation, bladder perforation, and buttock/thigh necrotizing abscess). The child with the ileal perforation after drain placement is the only patient who failed initial nonoperative therapy. CONCLUSIONS: The use of initial percutaneous aspiration/drainage of periappendiceal abscess followed by interval appendectomy is an effective approach. However, this management poses complication risks and uses considerable resources. Therefore, this strategy should be compared with early operation in a prospective trial.
OBJECTIVE: Given the perceived technical demands of laparoscopic appendectomy and the expected postoperative morbidity in patients with a well-defined abscess, initial percutaneous drainage has become an attractive option in this patient population. This strategy allows for a laparoscopic appendectomy to be performed in an elective manner at the convenience of the surgeon. However, the medical burden on the patient and on the quality of patient outcomes has not been described in the literature. Therefore, we audited our experience with initial percutaneous drainage followed by laparoscopic interval appendectomy to evaluate the need for a prospective trial. METHODS: After institutional review board approval, a retrospective chart review was performed on all children who presented with perforated appendicitis and a well-defined abscess and were treated by initial percutaneous aspiration/drainage followed by interval appendectomy between January 2000 and September 2006. Continuous variables are listed with standard deviation. RESULTS: There were 52 patients with a mean age of 9.0 +/- 3.9 years and weight of 34.4 +/- 18.8 kg. The mean duration of symptoms at presentation was 8.4 +/- 7.6 days. Percutaneous aspiration only was performed in 2 patients. The mean volume of fluid on initial aspiration/drain placement was 76.3 +/- 81.1 mL. The mean time to appendectomy was 61.9 +/- 25.2 days. The laparoscopic approach was used in 49 patients (94.2%), of which one was converted to an open operation. The mean length of hospitalization after interval appendectomy was 1.4 +/- 1.4 days. A recurrent abscess developed in 17.3% of the patients. Six patients (11.5%) required another drainage procedure. The mean total charge to the patients was $40,414.02. There were 4 significant drain complications (ileal perforation, colon perforation, bladder perforation, and buttock/thigh necrotizing abscess). The child with the ileal perforation after drain placement is the only patient who failed initial nonoperative therapy. CONCLUSIONS: The use of initial percutaneous aspiration/drainage of periappendiceal abscess followed by interval appendectomy is an effective approach. However, this management poses complication risks and uses considerable resources. Therefore, this strategy should be compared with early operation in a prospective trial.
Authors: L F Donnelly; K H Emery; A S Brody; T Laor; V M Gylys-Morin; C G Anton; S R Thomas; D P Frush Journal: AJR Am J Roentgenol Date: 2001-02 Impact factor: 3.959
Authors: Kuo Jen Tsao; Shawn D St Peter; Patricia A Valusek; Scott J Keckler; Susan Sharp; George W Holcomb; Charles L Snyder; Daniel J Ostlie Journal: J Pediatr Surg Date: 2007-06 Impact factor: 2.545
Authors: E Marty Knott; Priscilla Thomas; Nicole E Sharp; Alessandra C Gasior; Shawn D St Peter Journal: Pediatr Surg Int Date: 2013-07-27 Impact factor: 1.827
Authors: Massimo Sartelli; Gian L Baiocchi; Salomone Di Saverio; Francesco Ferrara; Francesco M Labricciosa; Luca Ansaloni; Federico Coccolini; Deepak Vijayan; Ashraf Abbas; Hariscine K Abongwa; John Agboola; Adamu Ahmed; Lali Akhmeteli; Nezih Akkapulu; Seckin Akkucuk; Fatih Altintoprak; Aurelia L Andreiev; Dimitrios Anyfantakis; Boiko Atanasov; Miklosh Bala; Dimitrios Balalis; Oussama Baraket; Giovanni Bellanova; Marcelo Beltran; Renato Bessa Melo; Roberto Bini; Konstantinos Bouliaris; Daniele Brunelli; Adrian Castillo; Marco Catani; Asri Che Jusoh; Alain Chichom-Mefire; Gianfranco Cocorullo; Raul Coimbra; Elif Colak; Silvia Costa; Koray Das; Samir Delibegovic; Zaza Demetrashvili; Isidoro Di Carlo; Nadezda Kiseleva; Tamer El Zalabany; Mario Faro; Margarida Ferreira; Gustavo P Fraga; Mahir Gachabayov; Wagih M Ghnnam; Teresa Giménez Maurel; Georgios Gkiokas; Carlos A Gomes; Ewen Griffiths; Ali Guner; Sanjay Gupta; Andreas Hecker; Elcio S Hirano; Adrien Hodonou; Martin Hutan; Orestis Ioannidis; Arda Isik; Georgy Ivakhov; Sumita Jain; Mantas Jokubauskas; Aleksandar Karamarkovic; Saila Kauhanen; Robin Kaushik; Alfie Kavalakat; Jakub Kenig; Vladimir Khokha; Desmond Khor; Dennis Kim; Jae I Kim; Victor Kong; Konstantinos Lasithiotakis; Pedro Leão; Miguel Leon; Andrey Litvin; Varut Lohsiriwat; Eudaldo López-Tomassetti Fernandez; Eftychios Lostoridis; James Maciel; Piotr Major; Ana Dimova; Dimitrios Manatakis; Athanasio Marinis; Aleix Martinez-Perez; Sanjay Marwah; Michael McFarlane; Cristian Mesina; Michał Pędziwiatr; Nickos Michalopoulos; Evangelos Misiakos; Ali Mohamedahmed; Radu Moldovanu; Giulia Montori; Raghuveer Mysore Narayana; Ionut Negoi; Ioannis Nikolopoulos; Giuseppe Novelli; Viktors Novikovs; Iyiade Olaoye; Abdelkarim Omari; Carlos A Ordoñez; Mouaqit Ouadii; Zeynep Ozkan; Ajay Pal; Gian M Palini; Lars I Partecke; Francesco Pata; Michał Pędziwiatr; Gerson A Pereira Júnior; Tadeja Pintar; Magdalena Pisarska; Cesar F Ploneda-Valencia; Konstantinos Pouggouras; Vinod Prabhu; Padmakumar Ramakrishnapillai; Jean-Marc Regimbeau; Marianne Reitz; Daniel Rios-Cruz; Sten Saar; Boris Sakakushev; Charalampos Seretis; Alexander Sazhin; Vishal Shelat; Matej Skrovina; Dmitry Smirnov; Charalampos Spyropoulos; Marcin Strzałka; Peep Talving; Ricardo A Teixeira Gonsaga; George Theobald; Gia Tomadze; Myftar Torba; Cristian Tranà; Jan Ulrych; Mustafa Y Uzunoğlu; Alin Vasilescu; Savino Occhionorelli; Aurélien Venara; Andras Vereczkei; Nereo Vettoretto; Nutu Vlad; Maciej Walędziak; Tonguç U Yilmaz; Kuo-Ching Yuan; Cui Yunfeng; Justas Zilinskas; Gérard Grelpois; Fausto Catena Journal: World J Emerg Surg Date: 2018-04-16 Impact factor: 5.469