Therapeutic Consideration of Periappendiceal Abscess: an Evaluation of Non-surgical Treatment Followed by Minimally Invasive Interval Appendectomy

ABSTRACT

PURPOSE: Periappendiceal abscess (PAA) is a severe complicated appendicitis with high morbidity. Non-surgical treatment followed by interval appendectomy (IA) is associated with lower complication rate compared with emergency surgery (ES) and minimally invasive surgery (MIS) can be done more often. The purpose of this study is to assess the incidence and factors predictive of complications of surgery for PAA and to evaluate the clinical effectiveness of IA as a treatment policy to increase MIS. METHODS: Retrospectively, we reviewed 171 patients undergoing surgery for PAA between 2011 and 2016 at Ulsan University Hospital. The incidence and influence of different factors were assessed by univariate and multivariate analyses. RESULTS: In 171 patients, 28 (16.4%) developed postoperative complications, which included; wound complications (7.6%), intra-abdominal abscess (4.1%) and ileus (2.9%). In both analyses, only ES was independently associated with postoperative complications; (Relative risk, 15.0; 95% Confidence interval, 2.4~92.5). Comparing the IA and ES groups revealed that operative time, complication rate, laparoscopic approach, postoperative hospitalization, postoperative antibiotic use and bowel resection rate were significantly different. The postoperative complication rate of patients with PAA in ES group was 28.7%, which was statistically higher than that of IA group (3.6%). Especially, MIS rate was more than 9-times greater in the IA group (98.8% vs. 10.3%, p<0.001). Although the IA group required additional hospitalization, there was no statistical difference between the two groups in total length of hospital stay. CONCLUSION: Morbidity was high for patients who had emergency surgery for PAA. ES was the only factor associated with postoperative morbidity. IA can reduce the postoperative complication rate and allowed MIS to be used more often as a useful treatment policy for PAA.