Comparison of intra-abdominal abscess formation following laparoscopic and open appendicectomy in children.
BACKGROUND
Controversy exists over the association between laparoscopic (LA) and open appendicectomy (OA) and the formation of postoperative intra-abdominal abscesses (IAAs). Our aim was to compare the outcome following these two techniques in a pediatric population.


METHODS
A retrospective data collection was carried out on all patients undergoing either an LA or OA at a single center over a 26-month period. Patients were identified from a hospital database and theater records. An intra-abdominal abscess was defined as recorded pyrexia, a raised inflammatory marker, and radiologic confirmation of an intra-abdominal collection. Other parameters studied included wound infection, appendiceal perforation, hospital stay, conversion rate, microbiology, histology, radiologic investigation, and serologic analysis. Data were analyzed from using Fisher's exact and Mann-Whitney tests, as appropriate. A P-value of <0.05 was considered significant.


RESULTS
Two hundred children were identified, with a median follow-up of 18 months. Forty patients underwent an LA and 151 an OA. Nine patients underwent interval appendicectomy and were not included in the final data. There was no difference between the two groups in terms of baseline demographics, duration of stay (P = 0.5), or wound infection (P = 1.0). The incidence of an intra-abdominal abscess was 0 of 40 (0%) in the laparoscopic group and 5 of 151 (3.3%) in the open group, although this was not statistically significant (P = 0.8). The median time to postoperative diagnosis of abscess was 9 days (range, 8-11). A consultant was present in more laparoscopic procedures than open (88 versus 24%; P = 0.0001).


CONCLUSIONS
The rate of intra-abdominal abscess formation was not significantly different following either an LA or OA, although there were no intra-abdominal abscesses observed in the laparoscopic group. Further investigation could address this finding more accurately in a randomized, controlled trial.
Nataraja
Ramesh M
RM
Department of Pediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom. nataraja@doctors.org.uk
Bandi
Ashwath
A
Clarke
Simon A
SA
Haddad
Munther J
MJ
D018784:Abdominal Abscess / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D000293:Adolescent; D001062:Appendectomy / Q000009:adverse effects*; D001064:Appendicitis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome