Interval appendectomy in the laparoscopic era

Abstract

In the acute setting, patients with periappendiceal masses generally improve with broad-spectrum antibiotics with or without percutaneous catheter drainage, but whether or not to perform an interval appendectomy remains controversial. We have analyzed our experience over the past decade, comparing results from interval laparoscopic appendectomy (ILA) and interval open appendectomy (IOA). Medical records were reviewed for 56 patients who initially presented with the diagnosis of periappendiceal mass or abscess and who subsequently underwent interval appendectomy. Data were accumulated for both the initial hospitalization and interval appendectomy. Comparisons were made between period 1 (1987 to 1993) and period 2 (1994 to 1997). Follow-up data were obtained via telephone conversations with the patients. Patient characteristics with regard to age, sex, and comorbidities did not differ between the ILA and IOA groups. The number of patients undergoing CAT scan increased from 33% to 55%, whereas the initial hospital stay decreased from 7.42 to 4.61 days (P <0.001). The percentage of interval appendectomies performed by the laparoscopic method increased from 30% to 85%. The total operating room time did not differ (95 vs. 103 minutes), but die hospital stay was much shorter in the ILA group (0.55 vs. 3.07 days, P <0.001). There were no instances of intra-abdominal or wound infections in either group. In the later time period the mean hospital stay decreased to 0.38 days, with 59% of the operations performed on an outpatient basis. Following ILA, narcotic pain medication was used for an average of 1.3 days and the reported "time to return to full activities" was 2.5 days. ILA is a simple and safe procedure that can usually be performed on an outpatient basis. Given the minimal morbidity of the procedure, we believe that ILA should be considered for most patients who initially present with periappendiceal masses.