Comparison of intraabdominal abscess formation after laparoscopic and open appendicectomies in children.
OBJECTIVE
Although laparoscopic appendicectomy (LA) is an accepted alternative to the open appendicectomy (OA) approach, it has been suggested that there is a higher incidence of intraabdominal abscesses (IAAs). Our aim was to determine the incidence of IAA in 3 pediatric surgical centers routinely practicing both techniques.


METHODS
Data were collected retrospectively for pediatric patients undergoing LA or OA over an 8-year period. Analysis included IAA formation, appendicitis complexity, radiologic/histologic investigations, grade of surgeon, and wound infection.


RESULTS
A total of 1267 appendicectomies were performed (514 LAs and 753 OAs). There was no difference between the incidences of IAA (LA, 3.9% [19/491] vs OA, 3.9% [28/714]; P = 1.0). The incidence of IAA was increased in those with complicated appendicitis (34/375 [9.1%] vs 13/830 [1.6%]; P ≤ .0001). There was an increased proportion of those with complicated appendicitis in the LA group (182/491 [37.1%] vs 193/714 [27.0%]; P = .0002). Surgical trainees were more likely to be the primary surgeon in the OA group (79% vs 63%; P = .0001), although the incidence of IAA did not correlate with grade of surgeon. There was no significant difference in incidence of wound infection between groups (LA, 4.6% [8/173] vs OA, 2.5% [18/377]; P = .93).


CONCLUSIONS
This large retrospective study shows that the technique of appendicectomy does not appear to affect the incidence of IAAs. Patients with complicated appendicitis are more likely to develop an IAA regardless of technique.
Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK. nataraja@doctors.org.uk
Ramesh M
RM
Nataraja
Warwick J
WJ
Teague
Julie
J
Galea
Lynette
L
Moore
Munther J
MJ
Haddad
Thomas
T
Tsang
Sanjeev
S
Khurana
Simon A
SA
Clarke
D018784:Abdominal Abscess / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004322:Drainage; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009336:Necrosis; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D013021:South Australia / Q000453:epidemiology; D013492:Suppuration; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology
D000900:Anti-Bacterial Agents