Laparoscopic Drainage Versus Interventional Radiology for Management Of Appendicular Abscess : A Randomized Controlled Trial

Abstract

Background: Laparoscopic drainage of appendicular abscess has become a novel technique due to its advantages over interventional radiology like complete exploration of the abdomen, exclusion of other pathologies, excision of the appendix at same session, better cosmesis, decrease incidence of wound infection & incisional hernia, better visualization of surgical field, fine handling of edematous tissue and drainage of multiple collections. Methods: This prospective randomized controlled clinical trial included all patients who developed the manifestations of appendicular abscess and referred to the Zagazig University Hospital Emergency Department between January 2020 and February 2022. The study was prospectively approved by Zagazig University Faculty of Medicine Institutional Review Board (Approval Number: 55342/24.1.2020), and was retrospectively submitted in clinicaltrials.gov in 15/6/2022 (ClinicalTrials.gov ID: NCT05419440). The sample size was 172 patients divided into two equal group, laparoscopic group involved 86 patients (group1), interventional radiology group involved 86 patients (group2). Results: “Group 1 (laparoscopic drainage group) included 86 patients: 55.8% were males, with a mean age of 41.2 (± 12.2) years-old, while in group 2 (interventional radiology group) included 86 patients: 51.2% were males, with a mean age of 36.8 (± 10.9) years-old. The reported complications were bowel injury, fecal fistula, recurrence, pelvic collection and mortality with incidence rates of occurrence 1(1.2%), 3 (3.5%), 0 (0%), 0 (0%), 0(0%) respectively in group (1) while in group(2) were 5(5.8%), 0(0%), 3(3.5%), 8(9.3%), 1(1.2%) respectively. Regarding quality of life in both groups were excellent, good, poor with incidence rates of 48(55.8%), 38(44.2%), 0(0%) respectively in group (1), and 12(14%), 59(68.6%), 15(17.4%) respectively in group(2). Conclusion: Laparoscopic management of appendicular abscess can be safely applied in a good experienced hand with no mortality & morbidity, without the need for interval appendectomy.