OBJECTIVE: We hypothesized that immediate laparoscopic surgery for appendiceal abscess would result in faster recovery than conservative treatment. BACKGROUND: On the basis of the retrospective studies, conservative management of appendiceal abscess is recommended as a first line treatment, but some controversy exists. METHODS: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. RESULTS: 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, P = 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%), P = 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), P = 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, P = 0.002. CONCLUSIONS: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.
RCT Entities:
OBJECTIVE: We hypothesized that immediate laparoscopic surgery for appendiceal abscess would result in faster recovery than conservative treatment. BACKGROUND: On the basis of the retrospective studies, conservative management of appendiceal abscess is recommended as a first line treatment, but some controversy exists. METHODS: 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. RESULTS: 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, P = 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%), P = 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), P = 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, P = 0.002. CONCLUSIONS: 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.
Authors: J de Jonge; M D M Bolmers; G D Musters; C C van Rossem; W A Bemelman; A A W van Geloven Journal: Int J Colorectal Dis Date: 2019-06-07 Impact factor: 2.571
Authors: S Shekarriz; T Keck; P Kujath; J Shekarriz; T Strate; R Keller; E Schlöricke; J Nolde; A Ehlert; H Shekarriz Journal: Int J Colorectal Dis Date: 2019-01-22 Impact factor: 2.571
Authors: Salomone Di Saverio; Mauro Podda; Belinda De Simone; Marco Ceresoli; Goran Augustin; Alice Gori; Marja Boermeester; Massimo Sartelli; Federico Coccolini; Antonio Tarasconi; Nicola De' Angelis; Dieter G Weber; Matti Tolonen; Arianna Birindelli; Walter Biffl; Ernest E Moore; Michael Kelly; Kjetil Soreide; Jeffry Kashuk; Richard Ten Broek; Carlos Augusto Gomes; Michael Sugrue; Richard Justin Davies; Dimitrios Damaskos; Ari Leppäniemi; Andrew Kirkpatrick; Andrew B Peitzman; Gustavo P Fraga; Ronald V Maier; Raul Coimbra; Massimo Chiarugi; Gabriele Sganga; Adolfo Pisanu; Gian Luigi De' Angelis; Edward Tan; Harry Van Goor; Francesco Pata; Isidoro Di Carlo; Osvaldo Chiara; Andrey Litvin; Fabio C Campanile; Boris Sakakushev; Gia Tomadze; Zaza Demetrashvili; Rifat Latifi; Fakri Abu-Zidan; Oreste Romeo; Helmut Segovia-Lohse; Gianluca Baiocchi; David Costa; Sandro Rizoli; Zsolt J Balogh; Cino Bendinelli; Thomas Scalea; Rao Ivatury; George Velmahos; Roland Andersson; Yoram Kluger; Luca Ansaloni; Fausto Catena Journal: World J Emerg Surg Date: 2020-04-15 Impact factor: 5.469
Authors: Gaetano Poillucci; Lorenzo Mortola; Mauro Podda; Salomone Di Saverio; Laura Casula; Chiara Gerardi; Nicola Cillara; Luigi Presenti Journal: Updates Surg Date: 2017-11-03
Authors: Salomone Di Saverio; Arianna Birindelli; Micheal D Kelly; Fausto Catena; Dieter G Weber; Massimo Sartelli; Michael Sugrue; Mark De Moya; Carlos Augusto Gomes; Aneel Bhangu; Ferdinando Agresta; Ernest E Moore; Kjetil Soreide; Ewen Griffiths; Steve De Castro; Jeffry Kashuk; Yoram Kluger; Ari Leppaniemi; Luca Ansaloni; Manne Andersson; Federico Coccolini; Raul Coimbra; Kurinchi S Gurusamy; Fabio Cesare Campanile; Walter Biffl; Osvaldo Chiara; Fred Moore; Andrew B Peitzman; Gustavo P Fraga; David Costa; Ronald V Maier; Sandro Rizoli; Zsolt J Balogh; Cino Bendinelli; Roberto Cirocchi; Valeria Tonini; Alice Piccinini; Gregorio Tugnoli; Elio Jovine; Roberto Persiani; Antonio Biondi; Thomas Scalea; Philip Stahel; Rao Ivatury; George Velmahos; Roland Andersson Journal: World J Emerg Surg Date: 2016-07-18 Impact factor: 5.469