Page 30 - World Journal of Laparoscopic Surgery

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

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Selmy S Awad , Fahad H Qahtani , Faisal S Alsulaimani , Ahmad H Khalid , Qasem M Alharthi , Musab A AlThomali ,
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Nadiah G AlAmri , Abdullah A Alshamrani , Ahmed H Alsufyani , Fakad M AlSokyany , Abdullah A AlGhuraybi ,
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Abdulrahman A Almalki , Abdulrahman S Alghamdi , Azzah Alzahrani , Malak F Almogathali , Shumukh A Alkhammash ,
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Abdulaziz F Alotaibi , Talalalfatimi M Alhassan , Abdullah M Altalhi , Mahmoud R Abdulshafi , Elsayed Abdullah 21
Received on: 16 May 2022; Accepted on: 04 September 2022; Published on: 05 September 2023
AbstrAct
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.
Keywords: Appendicitis, Appendectomy, Laparoscopy, Open surgery, Periappendiceal abscess.
World Journal of Laparoscopic Surgery (2023): 10.5005/jp-journals-10033-1548
IntroductIon 1 Department of General Surgery, Mansoura University Hospitals,
The surgery of open appendectomy (OA) has become the gold Mansoura, Egypt, Egypt; Department of General Surgery, King Faisal
standard for the management of acute appendicitis (AP). However, Medical Complex, Taif, Makkah, Saudi Arabia
the operation of appendectomy itself has remained unchanged for 2–19 Department of General Surgery, King Faisal Medical Complex, Taif,
more than a century, and the treatment of periappendiceal abscess Makkah, Saudi Arabia
1–3
(PA) is controversial. Open surgery for PA is technically difficult 20,21 Department of General Surgery, Mansoura University Hospitals,
and may be associated with surgical complications (SCs). Moreover, Mansoura, Egypt, Egypt
persistent complaints, recurrent intra-abdominal abscesses, and Corresponding Author: Selmy S Awad, Department of General
multiple healthcare visits can complicate drainage techniques Surgery, Mansoura University Hospitals, Mansoura, Egypt, Phone:
followed by interval appendectomy (IA). 4,5 +20 0556466097, e-mail: selmysabry2007@yahoo.com
Till now, there is no standard universal treatment policy How to cite this article: Awad SS, Qahtani FH, Alsulaimani FS, et al.
among various physicians. The literature comparing urgent The Assessment of Perioperative Outcome and Cost-effectiveness
operative intervention and nonoperative management has of Laparoscopy versus Open Surgery in the Management of
increased nowadays investigating the nonoperative issue or the Periappendiceal Abscess: A Comparative Multicentric Study. World J
IA. Although the nonoperative strategy was advised by many Lap Surg 2023;16(1):29–35.
reviews and meta-analysis, because it was accompanied by a Source of support: Nil
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lower rate of complication and morbidity, one prospective Conflict of interest: None
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research concluded that urgent surgical treatment was superior Ethics approval and consent to participate: Available
© The Author(s). 2023 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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