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Stacy L. Krisher, MD; Allen Browne, MD; Albert Dibbins, MD; Nancy Tkacz, PNP; Michael Curci, MD

Arch Surg. 2001;136:438-441.

Hypothesis  The incidence of postoperative intra-abdominal abscess is higher after laparoscopic compared with open appendectomy for perforated appendicitis.

Methods  A historical cohort study of pediatric patients operated on for suspected appendicitis by open appendectomy or laparoscopic appendectomy compares the incidence of postoperative intra-abdominal abscess for each procedure.

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 appendixes removed by methods other than laparoscopy or right lower quadrant incision.

Interventions  Open appendectomy performed through a right lower quadrant incision 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 abscess after laparoscopic vs open appendectomy.

Results  In perforated appendicitis (170 patients), the incidence of postoperative 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) after laparoscopic vs open appendectomy. The results remained significant when controlled for age, sex, intraoperative irrigation, and preoperative antibiotics. Postoperative abscess in all acute, gangrenous, and perforated appendicitis after laparoscopic appendectomy was 6.4% vs 3.0% after open appendectomy. This was not statistically significant.

Conclusion  There is a significant increase in the incidence of postoperative intra-abdominal abscess with perforated appendicitis after laparoscopic compared with open appendectomy in pediatric patients.

From the University of Vermont School of Medicine, Burlington (Drs Browne, Dibbins, and Curci); and Maine Medical Center, Portland, (Dr Krisher and Ms Tkacz).

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