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Oral Presentation - 11
ARE INTRA-ABDOMINAL ABSCESSES MORE COMMON AFTER LAPAROSCOPIC OR OPEN APPENDICECTOMIES?
Aim of the Study:
Whilst laparoscopic appendicectomy (LA) is an accepted alternative to the open approach, it has been suggested that there is a higher incidence of intra-abdominal abscesses (IAA) following LA when compared to the open approach (OA). Our aim was to determine the incidence of IAA in three paediatric surgical centres routinely practicing both techniques.
Methods:
Data were collected retrospectively for paediatric patients (<18 years) undergoing LA or OA in three centres over an 8-year period. Patients were analysed for IAA formation, complexity of appendicitis, radiological and histological investigations, grade of surgeon, and wound infection. Complicated appendicitis was defined by gangrene or perforation on histology with correlation of intra-operative findings. Data were analysed using Fisher’s exact test; p-value of <0.05 was considered significant.
Main Results:
1267 appendicectomies were performed: 514 LA and 753 OA. 62 patients were excluded as they underwent interval or incidental procedures. There was no significant difference between the incidence of IAAs following LA (3.5%, 17/491) and OA (3.6%, 26/714), p=1.0. This finding was consistent in all 3 centres (p=1.0, p=1.0, p=0.6). Patients with complicated appendicitis developed more IAAs: 33/375 (8.8%) vs. 10/830 (1.2%). This was regardless of technique: 15/182 vs. 2/309 (LA, p=0.0001) and 18/193 vs. 8/521 (OA, p=0.0001), and despite more complicated appendicitis in the LA group: 182/491 vs. 193/714 (p=0.0002).
A surgical trainee was the primary surgeon in 58.7% (LA) vs. 83.8% (OA), p=0.0001, but IAA incidence did not correlate with grade of surgeon (5/245 vs. 8/149, p=0.09). 4.6% LA (8/174) vs. 2.5% OA (18/378) developed a wound infection (p=1.0). Postoperative IAAs were treated with intravenous antibiotics and if necessary radiological or surgical drainage.
Conclusion:
These data show technique of appendicectomy does not affect the incidence of IAAs, contradicting widely stated dogma. Rather, patients with complicated appendicitis are more likely to develop an IAA regardless of technique.