World Journal of Laparoscopic Surgery

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VOLUME 16 , ISSUE 1 ( January-April, 2023 ) > List of Articles

Original Article

The Assessment of Perioperative Outcome and Cost-effectiveness of Laparoscopy versus Open Surgery in the Management of Periappendiceal Abscess: A Comparative Multicentric Study

Selmy S Awad, Fahad H Qahtani, Faisal S Alsulaimani, Ahmad H Khalid, Qasem M Alharthi, Musab A AlThomali, Nadiah G AlAmri, Abdullah A Alshamrani, Ahmed H Alsufyani, Fakad M AlSokyany, Abdullah A AlGhuraybi, Abdulrahman A Almalki, Abdulrahman S Alghamdi, Azzah Alzahrani, Malak F Almogathali, Shumukh A Alkhammash, Abdulaziz F Alotaibi, Talalalfatimi M Alhassan, Abdullah M Altalhi, Mahmoud R Abdulshafi, Elsayed Abdullah

Keywords : Appendicitis, Appendectomy, Laparoscopy, Open surgery, Periappendiceal abscess

Citation Information : Awad SS, Qahtani FH, Alsulaimani FS, Khalid AH, Alharthi QM, AlThomali MA, AlAmri NG, Alshamrani AA, Alsufyani AH, AlSokyany FM, AlGhuraybi AA, Almalki AA, Alghamdi AS, Alzahrani A, Almogathali MF, Alkhammash SA, Alotaibi AF, Alhassan TM, Altalhi AM, Abdulshafi MR, Abdullah E. The Assessment of Perioperative Outcome and Cost-effectiveness of Laparoscopy versus Open Surgery in the Management of Periappendiceal Abscess: A Comparative Multicentric Study. World J Lap Surg 2023; 16 (1):29-35.

DOI: 10.5005/jp-journals-10033-1548

License: CC BY-NC 4.0

Published Online: 05-09-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Aim: To investigate the perioperative outcomes and cost-effectiveness of the laparoscopic approach for patients with periappendiceal abscess (PA) in comparison with the open approach. The controversy is still evolving as regards laparoscopic surgery in cases with complicated appendicitis in general. Materials and methods: Three-center analysis of the records’ data of candidates >14 years of age with PA operated from January 2017 until October 2020 by either laparoscopic or open approach. Demographic and clinical data, perioperative outcomes, and cost-effectiveness were recorded and analyzed. Results: Within the study period, 399 eligible cases with PA were identified by clinical evaluation conjoined with the US and/or CT, of which 143 patients underwent laparoscopic appendectomy (LA) and 256 patients had an open appendectomy (OA). The average operating time was 78 minutes for the LA group and 62 minutes for the OA group (p < 0.001). The mean hospital stay was 6.3 days for LA and 7.4 days for the OA group (p < 0.001). There were 18 cases in the LA group who had surgical site infections, and there were 27 ones in the OA group (p = 0.001). There were six patients who suffered from a recurrent intra-abdominal collection in the LA group and four cases in the other group (p = 0.37). Laparoscopic appendectomy had a lower odds for the development of any specific surgical complication in the multivariate analysis (OR, 0.381, p = 0.008). The total expenses of management were marginally higher by about $300 in the LA group. Conclusions: Laparoscopic appendectomy is an efficient and safe operative approach in the management of PA, and it exhibits clinically beneficial merits over OA against marginally longer operating time and higher management expenses. Clinical significance: Laparoscopic surgery for appendicitis complicated with an abscess is feasible and safe. It offers beneficial merits over the open approach.

  1. Taguchi Y, Komatsu S, Sakamoto E, et al. Laparoscopic versus open surgery for complicated appendicitis in adults: A randomized controlled trial. Surg Endosc 2016;30(5):1705–1712. DOI: 10.1007/s00464-015-4453-x.
  2. Thomson JE, Kruger D, Jann-Kruger C, et al. Laparoscopic versus open surgery for complicated appendicitis: a randomized controlled trial to prove safety. Surg Endosc 2015;29(7):2027–2032. DOI: 10.1007/s00464-014-3906-y.
  3. Katkhouda N, Mason RJ, Towfigh S, et al. Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg 2005;242(3):439–450. DOI: 10.1097/01.sla.0000179648.75373.2f.
  4. Keckler SJ, Tsao K, Sharp SW, et al. Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess. J Pediatr Surg 2008;43(6):977–980. DOI: 10.1016/j.jpedsurg.2008.02.019.
  5. You KS, Kim DH, Yun HY, et al. The value of a laparoscopic interval appendectomy for treatment of a periappendiceal abscess: experience of a single medical center. Surg Laparosc Endosc Percutan Tech 2012;22(2):127–310. DOI: 10.1097/SLE.0b013e318244ea16.
  6. Tanaka Y, Uchida H, Kawashima H, et al. More than one-third of successfully nonoperatively treated patients with complicated appendicitis experienced recurrent appendicitis: is interval appendectomy necessary? J Pediatr Surg 2016;51:1957–1961. DOI: 10.1016/j.jpedsurg.2016.09.017.
  7. Chau DB, Ciullo SS, Watson-Smith D, et al. Patient-centered outcomes research in appendicitis in children: Bridging the knowledge gap. J Pediatr Surg 2016;51(1):117–121. DOI: 10.1016/j.jpedsurg.2015.10.029.
  8. St Peter SD, Aguayo P, Fraser JD, et al. Initial laparoscopic appendectomy versus initial nonoperative management and interval appendectomy for perforated appendicitis with abscess: a prospective, randomized trial. J Pediatr Surg 2010;45(1):236–240. DOI: 10.1016/j.jpedsurg.2009.10.039.
  9. Deelder JD, Richir MC, Schoorl T, et al. How to treat an appendiceal inflammatory mass: operatively or nonoperatively?. J Gastrointest Surg. 2014;18(4):641–645. DOI: 10.1007/s11605-014-2460-1.
  10. Kleif J, Vilandt J, Gögenur I. Recovery and convalescence after laparoscopic surgery for appendicitis: a longitudinal cohort study. J Surg Res 2016;205(2):407–418. DOI: 10.1016/j.jss.2016.06.083.
  11. Ukai T, Shikata S, Takeda H, et al. Evidence of surgical outcomes fluctuates over time: results from a cumulative meta-analysis of laparoscopic versus open appendectomy for acute appendicitis. BMC Gastroenterol. 2016;16:37. DOI: 10.1186/s12876-016-0453-0.
  12. Wu JX, Dawes AJ, Sacks GD, et al. Cost effectiveness of nonoperative management versus laparoscopic appendectomy for acute uncomplicated appendicitis. Surgery 2015;158(3):712–721. DOI: 10.1016/j.surg.2015.06.021.
  13. Pokala N, Sadhasivam S, Kiran RP, et al. Complicated appendicitis–is the laparoscopic approach appropriate? A comparative study with the open approach: outcome in a community hospital setting. Am Surg 2007;73(8):737–742.
  14. Pirro N, Berdah SV. Appendicites: coelioscopie ou non? [Appendicitis: yes or no to laparoscopic approach?]. J Chir (Paris). 2006;143(3):155–159. DOI: 10.1016/s0021-7697(06)73643-2.
  15. So JBY, Chiong EC, Chiong E, et al. Laparoscopic appendectomy for perforated appendicitis. World J Surg. 2002;26(12):1485–1488. DOI: 10.1007/s00268-002-6457-7.
  16. Garg CP, Vaidya BB, Chengalath MM. Efficacy of laparoscopy in complicated appendicitis. Int J Surg 2009;7(3):250–252. DOI: 10.1016/j.ijsu.2009.04.007.
  17. Fukami Y, Hasegawa H, Sakamoto E, et al. Value of laparoscopic appendectomy in perforated appendicitis. World J Surg 2007;31(1):93–97. DOI: 10.1007/s00268-006-0065-x.
  18. Guller U, Hervey S, Purves H, et al. Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database. Ann Surg 2004;239(1):43–52. DOI: 10.1097/01.sla.0000103071.35986.c1.
  19. Kouwenhoven EA, Repelaer van Driel OJ, van Erp WF. Fear for the intraabdominal abscess after laparoscopic appendectomy: not realistic. Surg Endosc 2005;19(7):923–926. DOI: 10.1007/s00464-004-2083-9.
  20. Yau KK, Siu WT, Tang CN, et al. Laparoscopic versus open appendectomy for complicated appendicitis. J Am Coll Surg. 2007;205(1):60–65. DOI: 10.1016/j.jamcollsurg.2007.03.017.
  21. Shelton T, McKinlay R, Schwartz RW. Acute appendicitis: current diagnosis and treatment. Curr Surg 2003;60(5):502–505. DOI: 10.1016/S0149-7944(03)00131-4.
  22. Lintula H, Kokki H, Vanamo K. Single-blind randomized clinical trial of laparoscopic versus open appendicectomy in children. Br J Surg 2001;88(4):510–514. DOI: 10.1046/j.1365-2168.2001.01723.x.
  23. Sakorafas, G. H., Sabanis, D., Lappas, et al. (2012). Interval routine appendectomy following conservative treatment of acute appendicitis: is it really needed. World J Gastrointest Surg4(4):83–86. DOI: 10.4240/wjgs.v4.i4.83.
  24. Quartey B. Interval appendectomy in adults: a necessary evil?. J Emerg Trauma Shock2012;5(3):213–216. DOI: 10.4103/0974-2700.99683.
  25. Quezada F, Quezada N, Mejia R, et al. Laparoscopic versus open approach in the management of appendicitis complicated exclusively with peritonitis: a single center experience. Int J Surg 2015;13:80–83. DOI: 10.1016/j.ijsu.2014.11.027.
  26. Quah GS, Eslick GD, Cox MR. Laparoscopic appendicectomy is superior to open surgery for complicated appendicitis. Surg Endosc. 2019;33(7):2072–2082. DOI: 10.1007/s00464-019-06746-6.
  27. Garbutt JM, Soper NJ, Shannon WD, et al. Meta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy. Surg Laparosc Endosc 1999;9(1):17–26. PMID: 9950122.
  28. Kiriakopoulos A, Tsakayannis D, Linos D. Laparoscopic management of complicated appendicitis. JSLS 2006;10(4):453–456. PMID: 17575756.
  29. Hamill JK, Rahiri JL, Gunaratna G, et al. Interventions to optimize recovery after laparoscopic appendectomy: a scoping review. Surg Endosc 2017;31(6):2357–2365. DOI: 10.1007/s00464-016-5274-2.
  30. Jaschinski T, Mosch C, Eikermann M, et al. Laparoscopic versus open appendectomy in patients with suspected appendicitis: A systematic review of meta-analyses of randomized controlled trials. BMC Gastroenterol 2015;15:48. DOI: 10.1186/s12876-015-0277-3.
  31. Markar SR, Penna M, Harris A. Laparoscopic approach to appendectomy reduces the incidence of short- and long-term post-operative bowel obstruction: systematic review and pooled analysis. J Gastrointest Surg 2014;18(9):1683–1692. DOI: 10.1007/s11605-014-2572-7.
  32. Mentula P, Sammalkorpi H, Leppäniemi A. Laparoscopic surgery or conservative treatment for appendiceal abscess in adults? A randomized controlled trial. Ann Surg 2015;262(2):237–242. DOI: 10.1097/SLA.0000000000001200.
  33. Meshikhes AW. Management of appendiceal mass: controversial issues revisited. J Gastrointest Surg 2008;12(4):767–775. DOI: 10.1007/s11605-007-0399-1.
  34. Deakin DE, Ahmed I. Interval appendicectomy after resolution of adult inflammatory appendix mass: Is it necessary? Surgeon 2007;5(1):45–50. DOI: 10.1016/s1479-666x(07)80111-9.
  35. Tsai CC, Lee SY, Huang FC. Laparoscopic versus open appendectomy in the management of all stages of acute appendicitis in children: a retrospective study. Pediatr Neonatol 2012;53(5):289–294. DOI: 10.1016/j.pedneo.2012.07.002.
  36. Ingraham AM, Cohen ME, Bilimoria KY, et al. Comparison of outcomes after laparoscopic versus open appendectomy for acute appendicitis at 222 ACS NSQIP hospitals. Surgery 2010;148(4):625–637. DOI: 10.1016/j.surg.2010.07.025.
  37. Blackmore C, Tanyingo D, Kaplan GG, et al. A comparison of outcomes between laparoscopic and open appendectomy in Canada. Can J Surg 2015;58(6):431–432. DOI: 10.1503/cjs.012715.
  38. Markides G, Subar D, Riyad K. Laparoscopic versus open appendectomy in adults with complicated appendicitis: systematic review and meta-analysis. World J Surg 2010;34(9):2026–2040. DOI: 10.1007/s00268-010-0669-z.
  39. Ball CG, Kortbeek JB, Kirkpatrick AW, et al. Laparoscopic appendectomy for complicated appendicitis: an evaluation of postoperative factors. Surg Endosc 2004;18(6):969–973. DOI: 10.1007/s00464-003-8262-2.
  40. Tate JJ. Laparoscopic appendicectomy. Br J Surg 1996;83(9):1169–1170. DOI: 10.1046/j.1365-2168.1996.02476.x.
  41. Tsao KJ, St Peter SD, Valusek PA, et al. Adhesive small bowel obstruction after appendectomy in children: comparison between the laparoscopic and open approach. J Pediatr Surg. 2007;42(6):939–942. DOI: 10.1016/j.jpedsurg.2007.01.025.
  42. Moore DE, Speroff T, Grogan E, Poulose B, Holzman MD. Cost perspectives of laparoscopic and open appendectomy. Surg Endosc 2005;19(3):374–378. DOI: 10.1007/s00464-004-8724-1.
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