The Incidence of Intraabdominal Abscess Formation Following Laparoscopic Appendicectomy in Children: A Systematic Review and Meta-analysis

Nataraja, Ramesh M.; Loukogeorgakis, Stavros; Sherwood, William; Clarke, Simon A.; Haddad, Munther J.

doi:10.1089/lap.2012.0522

Cited by 27 publications

(18 citation statements)

References 68 publications

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“…Compared with previous studies, this study is the largest case series of patients examining the outcomes of post-appendicectomy IAA in an adult population. 19,[21][22][23][24][25][26] The results of this case series provide support that selective non-operative management of small (<4 cm) IAA is safe and effective. None of the 26 patients managed nonoperatively required an invasive intervention.…”

Section: Discussionsupporting

confidence: 57%

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Non‐operative management of small post‐appendicectomy intra‐abdominal abscess is safe and effective

Collins

Allaway

Eslick

et al. 2020

ANZ Journal of Surgery

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Background: Intra-abdominal abscess (IAA) post-appendicectomy occurs in 1.4-4.4% of cases. Non-operative management of small (<4 cm) post-appendicectomy IAA in children is well established, but minimal evidence exists in adults. Percutaneous catheter drainage is considered standard treatment for IAA, yet outcome data for post-appendicectomy IAA are sparse. The aims of this study were to assess the effectiveness of non-operative management of small (<4 cm diameter) IAA and the outcomes of percutaneous drainage for larger (>4 cm) IAA post-appendicectomy. Methods: A retrospective case note review of a series of patients with a postappendicectomy IAA between 2006 and 2017 was conducted. IAAs were treated selectively; small (<4 cm) IAAs were managed non-operatively and larger IAAs were managed with percutaneous drainage. Results: A total of 4901 patients had an appendicectomy. Forty-two (0.9%) developed a post-operative IAA. Sixteen (38%) had a percutaneous drainage and 26 (62%) had non-operative management. The percutaneous drainage group had a higher proportion of complicated appendicitis (75%) compared to the non-operative group (42%, P = 0.04). The percutaneous drainage group had a significantly higher leucocytosis (P = 0.01) and C-reactive protein (P = 0.02). All patients managed non-operatively resolved without the need for invasive procedures. In the percutaneous drainage group, six had aspiration alone, nine had a percutaneous drain and one was abandoned. Three required repeat percutaneous drainage and four (25%) required operative drainage. Seven patients (34%) of the percutaneous drainage group had grade II or III complications. Conclusion: This case series study provides support that small (<4 cm) IAA postappendicectomy can be safely and effectively managed non-operatively.

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Section: Discussionsupporting

confidence: 57%

“…The role of non-operative management for post-appendicectomy IAA in children is well established, [21][22][23][24][25] with the main criteria for success being size less than 4 cm in diameter. 21,25 However, there is very little data for the role of non-operative treatment of postappendectomy IAA in adults.…”

Section: Introductionmentioning

confidence: 99%

Non‐operative management of small post‐appendicectomy intra‐abdominal abscess is safe and effective

Collins

Allaway

Eslick

et al. 2020

ANZ Journal of Surgery

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“…This includes decreased pain, earlier mobilization and decreased wound sepsis. [20][21][22][23] Our study included higher rates of grossly perforated appendicitis and localized pus or four-quadrant pus than other studies in the literature. These studies included patients with suppurative appendicitis.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Lavage Versus Suction Only in Complicated Acute Appendicitis: A Prospective Randomized Control Trial

Sardiwalla

Koto

2018

International Surgery

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Background: Laparoscopic appendectomy for complicated appendicitis presents a challenge with concerns about pelvic collections. It is unclear whether lavage or if simple suctioning of pus influences complications. Methods: A prospective, single,-blinded, randomized control trial was conducted. Patients with suspected acute appendicitis were consented. Those found to have complicated appendicitis (perforation, localized pus, or four-quadrant pus) at laparoscopy were randomized to suction or lavage. Exclusions included conversions and drainage of abscess only. Lavage consisted of 3 liters of lavage. Intra-abdominal abscess that required reintervention (i.e., relook, percutaneous drainage) was the primary outcome. Hospital stay and return of bowel function were also recorded. Results: A total of 213 patients were assessed for eligibility. We excluded 157 patients, as they had simple appendicitis; 7 patients were converted to laparotomies; 5 had abscesses but the appendix was not removed. We analyzed 86 patients. The mean age was 26.6 years (14–74). We lavaged 42 (48.8%) patients and 44 (51.2%) were suctioned. Four-quadrant pus was present in 26 (30.2%) of the patients overall. Complications developed in 20 (47.5%) of the patients that were lavaged versus 12 patients (27.1%) with suction only. The difference did not reach significance due to sample size ( P = 0.0739). Operative time was longer in the lavage group by 30 minutes ( P = 0.086). If a complication developed, then the hospital stay was significantly prolonged 13.5 days versus 5 days ( P < 0.001). The study was stopped by the internal review board due to the excess risk with lavage. Conclusions: This exploratory study into lavage versus suction only in complicated appendicitis revealed potential harm with lavage. The study was stopped prematurely by the internal review due to the excess risk experienced by the lavage group, thus the study did not reach statistical power. If a patient with complicated appendicitis developed any complication, hospital stay was longer.

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“…A recent meta-analysis published by Aziz and colleagues [41] found no difference in the rates of IAA formation when comparing laparoscopy with open surgery. Likewise, studies comparing the effects of appendectomy in older age found no statistical difference in IAA formation among patients older than 60 undergoing laparoscopic versus open appendectomy [42,43]. A summary of these meta-analyses and others is in Table 4.…”

Section: Three-incision Laparoscopy Versus Open Surgerymentioning

confidence: 96%

Abscess After Appendectomy

Levin

Pegoli

2015

Advances in Surgery

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The Incidence of Intraabdominal Abscess Formation Following Laparoscopic Appendicectomy in Children: A Systematic Review and Meta-analysis

Abstract: The IAA incidence is comparable in LA versus OA in pediatric patients. LA confers a significantly lower risk of other postoperative complications, including WI and SBO.

Cited by 27 publications

References 68 publications

Non‐operative management of small post‐appendicectomy intra‐abdominal abscess is safe and effective

Non‐operative management of small post‐appendicectomy intra‐abdominal abscess is safe and effective

Laparoscopic Lavage Versus Suction Only in Complicated Acute Appendicitis: A Prospective Randomized Control Trial

Abscess After Appendectomy

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