Elective versus urgent laparoscopic appendectomy for complicated appendicitis.
OBJECTIVE
Urgent appendectomy in patients with acute appendicitis (AA) complicated by abscess or phlegmon is associated with a high rate of complications. Recent developments in CT scanning have allowed patients with complicated appendicitis to be better identified. We choose to treat these patients with initial antibiotic therapy followed by elective appendectomy. We reported the results of this strategy and compared it with urgent appendectomy.


METHODS
A retrospective analysis of patients diagnosed with complicated acute appendicitis (CAA) between 1998 and 2007 treated either by urgent appendectomy or with antibiotic therapy and elective appendectomy was performed. We assessed the efficacy of antibiotic therapy for CAA. We compared the postoperative course between urgent and elective appendectomy.


RESULTS
We treated 56 patients with CAA: 40 by urgent appendectomy and 16 by antibiotics. All 16 patients improved with no need for urgent surgery, with 15 undergoing elective appendectomy. Postoperative complications were significantly lower in the elective group. Conversion rate and mean operative time were also lower but not significantly different. However, the duration of total hospital stay, antibiotic therapy and sick leave were higher.


CONCLUSIONS
Initial antibiotic therapy followed by elective appendectomy may be proposed in patients diagnosed with CAA.
Balzarotti
R
R
Department of Digestive Surgery, Hôpital Antoine Béclère, Clamart Cedex, France.
Smadja
C
C
Saint Yves
G
G
Carloni
A
A
Maitre
S
S
Helmy
N
N
Vons
C
C
D018784:Abdominal Abscess / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery*; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents