Intra-abdominal collections following laparoscopic versus open appendicectomy: an experience of 516 consecutive cases at a district general hospital.
BACKGROUND
The objective of this study is to evaluate the incidence of intra-abdominal collections (IACs) in all patients undergoing laparoscopic (LA) and open appendicectomy (OA) from April 2009 to October 2011 in a district general hospital with expertise in minimally invasive surgery (MIS).


METHODS
A retrospective review of all patients undergoing appendicectomy in the specified time period was carried out. IACs were identified from various in-hospital data resources. Severity of appendicitis was assessed from histology reports.


RESULTS
516 patients were identified, of whom 242 (47 %) underwent OA and 274 (53 %) LA. Twenty-six (5 %) patients were found to have IACs postoperatively. Fifteen (5.5 %) IACs were identified in the laparoscopic group and 11 (4.5 %) in the open group. There was no statistically significant difference in the risk of developing IACs in open versus laparoscopic groups [odds ratio (OR) 1.22, confidence interval (CI) 0.55-2.70, P = 0.63]. Patients were twelve times more likely to develop IACs with an appendix identified as being necrotic or perforated on histology (OR 12.24, CI 5.29-28.32, P < 0.0001). There was a trend towards shorter total hospital stay in the LA (3.58 days, CI 3.0-4.1 days) compared with OA (4.31 days, CI 3.7-4.9 days, P = 0.082) group, although this was not statistically significant.


CONCLUSIONS
Increased rates of IAC following LA have been identified in some studies. Our series shows that, in a centre with adequate MIS experience, the IAC rate following LA is comparable to that of the open approach and should not deter surgeons with adequate support and resources.
Department of General & Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK. d.wilson@doctors.org.uk
Daniel G G
DG
Wilson
Amanda K
AK
Bond
Nikhil
N
Ladwa
Muhammad S
MS
Sajid
Mirza K
MK
Baig
Parvinderpal
P
Sains
D018784:Abdominal Abscess / Q000209:etiology*; D000328:Adult; D001062:Appendectomy / Q000009:adverse effects* / Q000379:methods*; D001064:Appendicitis / Q000601:surgery; D001065:Appendix / Q000293:injuries / Q000473:pathology / Q000601:surgery; D002432:Cecum / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009336:Necrosis / Q000601:surgery; D012189:Retrospective Studies; D012737:Sex Factors