Intra-abdominal abscess after laparoscopic appendectomy for perforated appendicitis

Hypothesis: The incidence of postoperative intraabdominal abscess is higher after laparoscopic compared with open appendectomy for perforated appendic itis. Methods: A historical cohort study of pediatric patients operated on for su spected appendicitis by open appendectomy or laparoscopic appendectomy comp ares the incidence of postoperative intra-abdominal abscess for each proced ure. Setting: A tertiary care center. Patients: Five hundred thirty-eight pediatric patients were operated on for suspected appendicitis at our institution between 1974 and 1999. Of these, 453 were included in the study. Of the excluded patients, 9 had incomplete medical records, 69 had normal or interval appendectomies, and 7 had appen dixes removed by methods other than laparoscopy or right lower quadrant inc ision. Interventions: Open appendectomy performed through a right lower quadrant i ncision or laparoscopic appendectomy performed through a 3-trocar approach by 1 of 3 pediatric surgeons at our institution. Main Outcome Measure: The incidence of postoperative intra-abdominal absces s after laparoscopic iis open appendectomy. Results: In perforated appendicitis (170 patients), the incidence of postop erative abscess after laparoscopic appendectomy was 24% vs 4.2% after open appendectomy. The relative risk ratio of developing a postoperative abscess after perforated appendicitis was 5.6 (confidence interval, 2.1-16.0) afte r laparoscopic VS open appendectomy. The results remained significant when controlled for age, sex, intraoperative irrigation, and preoperative antibi otics. Postoperative abscess in all acute, gangrenous, and perforated appen dicitis after laparoscopic appendectomy was 6.4% vs 3.0% after open appende ctomy. This was not statistically significant. Conclusion: There is a significant increase in the incidence of postoperati ve intra-abdominal abscess with perforated appendicitis after laparoscopic compared with open appendectomy in pediatric patients.