Intraabdominal abscess rate after laparoscopic appendectomy

BACKGROUND: Studies suggest increased intraabdominal abscess (IA) rates fol lowing laparoscopic appendectomy (LA), especially for perforated appendicit is. Consequently, an open approach has been advocated. The aim of our study is to compare IA rates following LA performed by a laparoscopic surgery an d a general surgical service within the same institution. METHODS: Data of LA patients treated at Los Angeles County-University of So uthern California (LAC-USC) Medical Center between March 1992 and June 1997 were reviewed. The main outcome measure was postoperative IA. RESULTS: In all, 645 LA were reviewed. A total of 413 LA (285 acute, 61 gan grenous, 61 perforated appendicitis) were performed by three general surgic al services (10 attendings). Ten abscesses occurred postoperatively (2.4%), 6 with perforated appendicitis. After the laparoscopic service was introdu ced, 232 standardized LA (126 acute, 46 gangrenous, 60 perforated) were per formed by two attendings. One IA occurred (gangrenous appendicitis). The IA rate for perforated appendicitis was significantly lower on the laparoscop ic service (P = 0.025), There was no difference in IA rates for acute and g angrenous appendicitis. There was no mortality in either group. CONCLUSION: IA rate following LA for perforated appendicitis was significan tly reduced on the laparoscopic service. Mastery of the learning curve and addition of specific surgical techniques explained this improved result. Th erefore, laparoscopic appendectomy for complicated appendicitis may not be contraindicated, even for perforated appendicitis. (C) 2001 by Excerpta Med ica, Inc.