title: Laparoscopic drainage of intraabdominal abscess after appendectomy: an alternative to laparotomy in cases not amenable to percutaneous drainage.
abstract: OBJECTIVE
  Postoperative abscesses after appendectomy occur in 3% to 20% of cases and are more common in cases of perforated appendicitis. Smaller abscesses are often amenable to antibiotic therapy, but surgical drainage remains the mainstay of treatment for larger collections. Surgical options generally include percutaneous drainage and open laparotomy. Laparoscopic drainage of these abscesses has not been well characterized in the pediatric population.
  
  
  OBJECTIVE
  The aim of this study was to describe our experience with laparoscopic drainage of postappendectomy abscesses that were not amenable to percutaneous drainage.
  
  
  METHODS
  This study is a retrospective review of all pediatric patients who underwent laparoscopic appendectomy for acute appendicitis at a tertiary pediatric medical center during a 4-year period (2006-2009). The review focuses on patients who developed abscesses after appendectomy, were unable to undergo percutaneous drainage, and were treated with laparoscopic abscess drainage.
  
  
  RESULTS
  Twelve patients (7 male and 5 female) underwent laparoscopic drainage of postappendectomy abscesses. The mean age was 8.5 years old (range, 3-14 years). A clinical diagnosis of postoperative abscess was made when fevers, pain, and leukocytosis persisted despite broad-spectrum antibiotics. Computed tomography was performed in all patients. Abscesses ranged between 3 and 11 cm in size. The mean length of time between initial appendectomy and drainage procedure was 10 days. There were no complications specifically related to the laparoscopic drainage procedure. The mean length of the drainage procedure was 77 minutes (range, 30-196 minutes). The mean hospital length of stay after laparoscopic drainage was 6.5 days (range, 3-13 days) with patients maintained on intravenous antibiotics until afebrile and without leukocytosis.
  
  
  CONCLUSIONS
  Laparoscopic drainage is a safe and effective alternative for intraabdominal abscesses that occur after laparoscopic appendectomy. We recommend it as an alternative to open laparotomy when percutaneous drainage is not an option.
authors.affiliation: Department of Surgery, University of Hawaii Surgical Residency Program, Honolulu, HI 96813, USA. jjclark_md@yahoo.com
authors.forename: Justin J
authors.initials: JJ
authors.lastname: Clark
authors.forename: Sidney M
authors.initials: SM
authors.lastname: Johnson
mesh_terms: D018784:Abdominal Abscess / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents